



COPYRIGHT DEPOSIT 



astoerssitie educational jHonograptyss 

EDITED BY HENRY SUZZALLO 

PRESIDENT OF THE UNIVERSITY OF WASHINGTON, SEATTLE 

THE 

TEACHING OF HYGIENE 

IN THE GRADES 



BY 

Jf MACE ANDRESS, Ph.D. 

Head of the department of psychology, boston normal school 

formerly head of the department of psychology and 

hygiene, state normal school, worcester, mass. 




HOUGHTON MIFFLIN COMPANY 

BOSTON, NEW YORK AND CHICAGO 

<$fre ttfaetfifce pte0 Cambridge 






COPYRIGHT, 1918, BY J. MACE ANDRESS 
ALL RIGHTS RESERVED 



id 



Wot fcibersibe $re*£ 

CAMBRIDGE . MASSACHUSETTS 
U . S . A 

FEB 19 1918 
©CI.A481733 



A*-0. I 



To 
W. H. BURNHAM 

PIONEER IN HEALTH EDUCATION 



• 



CONTENTS 

Editor's Introduction vii 

Preface xi 

I. The Fundamental Importance of Hygiene^-— 

in the Curriculum i 

II. The Status of the Teaching of Hygiene . 12 

III. The Goals of Instruction .... 26 

IV. Suggestions on Method 39 

V. Important Problems and their Solution . 86 

VI. The Teaching of Hygiene in the Rural 

Schools 150 

Bibliography 165 

Selected List of Best Reference Books 

for Teachers 172 

Outline 175 



EDITOR'S INTRODUCTION 

The impotency of mere knowledge is gradually 
being recognized by the schoolmaster. Long he 
has believed in the magical influence of informa- 
tion about human conduct. Centuries of unchang- 
ing pedagogical tradition bear witness to his faith 
in the omnipotence of facts. Now, somewhat sud- 
denly, this sublime confidence in pure, or rather 
isolated, intellectual training, is disturbed by lay 
critic and psychological skeptic. 

As long as theory and practice were the sep- 
arate responsibilities of two different classes of 
people, the dependence of each on the other could 
not be fully perceived, and in consequence the 
assumed self-sufficiency of each was safe from 
destruction. It is precisely because contempo- 
raneous intellectuality has assumed practical 
aims, and because practical work has sought an 
efficiency that requires scientific aid, that we are 
now no longer content in education to worship 
pure learnedness. When learning ceases to be 
worshiped exclusively for its own sake and comes 
to gain the sanction of the actual service it may 
vii 



EDITOR'S INTRODUCTION 

render to human living, it is necessarily sub- 
jected to criticism it has not known before. As 
a product of this criticism, two striking changes 
occur in the intellectual discipline of our schools. 
First, the intellectual content of the school curric- 
ula is chosen on a different basis — a practical 
one. It includes elements previously omitted and 
omits those before included. Second, the intel- 
lectual activity is dealt with under conditions 
approximating normality. It begins in proper 
motivation and ends in expression to a degree 
unknown in traditional schools. Cognition is 
related to its emotional backgrounds and to its 
functional terminus. More useful subject-mat- 
ter assimilated under natural psychological con- 
ditions, rather than isolated information arti- 
ficially acquired, is the characteristic demand 
of every modernized course of study. The critics 
have had their way. 

Certain new practical ambitions of the public 
schools have revealed the weakness of educa- 
tional formalism more readily than some of its 
ancient functions. The teaching of language and 
literature has been slow to respond to reform, 
whereas the attempts to teach morals, art, 
civics, and health have been sensitive. Theirs 
was a practical purpose, and they were bound to 
viii 



EDITOR'S INTRODUCTION 

be checked by somewhat concrete social results. 
Mere information about goodness, beauty, and 
personal efficiency is too fragmentary not to be 
noted. Perhaps our inevitable disappointment 
as to the results of book learning in the field of 
health education has been most startling. Health 
is more tangible than morals or aesthetics, hence 
we have recognized the need of a change in peda- 
gogical procedure. This change we are now ob- 
taining. The memorization of the names of all the 
bones of the body has passed. Gone, too, is our 
old reliance on remembered descriptions of the 
old textbook physiology. Even rules for daily 
hygienic behavior seem not to be so highly valued 
as before. They, too, have failed to cover the 
gap between knowing and doing. The pedagogical 
faith is now pinned to action properly motivated, 
functionally explained, and much practiced. 
Health education is based on a regimen rather than 
on a textbook. It concerns every moment of the 
child's daily life rather than a study period or 
recitation spent at a school desk. 

This new training in hygiene reveals itself 
most characteristically in the reformed teaching 
of progressive teachers in the elementary school 
grades. Its plan and its method should be known 
to all teachers of young children. To aid in this 
ix 



EDITOR'S INTRODUCTION 

purpose we present the following monograph. 
It is a guide to the useful and effective teaching 
of hygiene. It indicates, with practical social 
surveys as a basis, the hygiene which has the 
most frequent and crucial value in daily life. It 
gives a hundred estimates of the worth of subject- 
matter, and a thousand suggestions as to right 
methods of teaching. Finally it includes references 
to further stores of wisdom too expansive to be 
given here, and too detailed to interest the teacher 
just beginning to think on the problem. 



PREFACE 

The purpose of this book is to give teachers and 
school administrators some practical suggestions 
on the teaching of hygiene in the grades. The 
word " hygiene " is here given a broader interpre- 
tation than giving instruction to children in a 
formal lesson a few minutes every day or week; 
it refers to those influences brought to bear on 
the children by the teacher, both incidental' and 
systematic, to conserve and improve their health. 
An effort has been made to emphasize the fol- 
lowing points: (i) the value of health to the 
individual and society; (2) the relative impor- 
tance of hygiene in the curriculum ; (3) the present 
unsatisfactory status of the teaching of hygiene; 

(4) the specific goals of the teaching of hygiene; 

(5) effective methods of teaching; (6) the appli- 
cation of these methods to the most significant 
problems of teaching; (7) the special health 
problems of both city and rural schools and their 
solution; and (8) definite references to the best 
literature for teachers and pupils. 

Many of the ideas herein presented have ap- 
xi 



PREFACE 

peared in articles by the writer published in the 
Elementary School Teacher, Educational Standards, 
The Rural School Teacher, The American Journal 
of School Hygiene, and in a chapter in Educational 
Hygiene (Charles Scribners' Sons), edited by 
L. W. Rapeer. This chapter is entitled "The 
Teaching of Hygiene in Elementary Schools." 

Special thanks are due Miss Laura S. Plummer, 
Dr. W. H. Burnham, and my wife, who read the 
manuscript and gave helpful suggestions, also to 
Mr. Arthur Kallom, who assisted in the reading 
of the proof. 

J. Mace Andress 

Boston Normal School 
December, igiy 



THE TEACHING OF HYGIENE 
IN THE GRADES 



THE FUNDAMENTAL IMPORTANCE OF 
HYGIENE IN THE CURRICULUM 

Hygiene is an applied science of practical value 
having as its objects the conservation and im- 
provement of man's health and the lengthening 
of human life. That health is of fundamental im- 
portance in life and education, taking precedence 
over all other values, is the thesis of this chapter. 

i. The value of health 

It is a common experience that loss of health 
and life leads to keen mental and physical anguish. 
If hygiene can alleviate this suffering in the slight- 
est degree, its position in the elementary-school 
curriculum is abundantly justified, but it may do 
more ; for preventable illness or postponable death 
is always a distinct economic waste. It is possi- 
ble within reasonable limits to estimate this eco- 
nomic waste and so put a monetary value on a 
i 



THE TEACHING OF HYGIENE 

practical kind of hygiene. It is not assumed here 
that money is a thing of greatest worth, but, since 
the discomfort and pain associated with illness 
are well understood and are quite immeasurable, 
let us pass to a consideration of the economic value 
of health and long life, topics which are often but 
vaguely comprehended. 

We may best approach these topics by re- 
viewing briefly our national losses due to a lack 
of applied hygiene. According to Dr. Irving 
Fisher (25), the newborn child has a net worth of 
$90. Since a child must be fed, clothed, housed, 
and educated up to at least the age of fourteen, 
or, in the case of one who learns a profession, 
until twenty or twenty-five, before there is any 
appreciable return on the investment so that the 
individual becomes self-supporting and economi- 
cally productive, the vital value of the child 
steadily increases every year after birth. At the 
age of twenty a human life represents $4000. 
There comes a time, of course, later in life, when 
the investment has been partially returned and 
when one's productive power wanes, that the 
economic value decreases. Dr. Fisher estimates 
that the average economic loss through prevent- 
able death is $1700. Since 42 per cent of the 
1,500,000 deaths are preventable or postponable, 
2 



IMPORTANCE OF HYGIENE 

there is an annual loss to the Nation each year of 
approximately one billion dollars. When we con- 
sider that one third of the deaths due to typhoid 
and one fifth of those caused by tuberculosis 
occur at a time when our young people are in 
high schools and colleges, a period representing 
the maximum investment of society for the pre- 
paration of the individual for future usefulness, 
we get a good idea of some of the havoc that is 
wrought. 

Preventable sickness, not resulting in death, 
also represents a tremendous financial loss. The 
cost of caring for the sick — nurses, medicine, 
medical attendance, etc. — and the loss of wages 
amount to probably another billion of dollars. 
The share of the American workman in these 
losses is enormous. According to the estimate of 
the American Association for Labor Legislation 
(7) the industrial workers in the United States 
lose each year because of illness about 284,000,000 
days, involving a loss to industry and in wages 
and medical cost amounting to $772,857,000. It 
is estimated that one third of this loss is prevent- 
able. 

It must not be assumed, of course, that these 
losses are purely individual, that he who is sick 
pays his own bills alone. These wastes gnaw at 

3 



THE TEACHING OF HYGIENE 

the very vitals of society. The workman who 
falls sick not only sustains individual losses, but 
he tends to cripple industry and increase the cost 
of the manufactured article to the consumer. 
Sickness and death inevitably entail social hard- 
ship. For example, the English Royal Commis- 
sion on Poverty states that 55 to 60 per cent of 
the poverty of Great Britain is due to illness. 
Dr. Baird (8) says the report of the Charity 
Organization of New York City seems to con- 
firm the report of this commission. The cruel 
blight of poverty not only closes the door of op- 
portunity to the individual, but places a heavy 
burden upon society. A family left destitute must 
often be supported by public or private charity. 
Children are often denied proper food, shelter, 
clothing, and sanitary surroundings, and are 
usually forced to leave school early to seek em- 
ployment. As a result their usefulness to society 
is greatly diminished. Every individual who is 
not dependent upon society for his livelihood 
helps to shoulder a vast economic burden due 
to preventable illness. Rapeer (50) estimates that 
the average family contributes one dollar in five 
of its regular income through some form of taxa- 
tion, direct or indirect, because of ill-health. The 
money loss is important, but the direct losses to 

4 



IMPORTANCE OF HYGIENE 

American citizenship, so subtle that they cannot 
be measured, are alarming. 

When we come to sum up in a word the value 
of health, we may say that it is a basic factor in 
individual and social efficiency and happiness. 
This is true to a remarkable extent of the school 
itself. Rapeer estimates that ill-health and phys- 
ical defects function largely in causing about 
fifteen per cent of elimination, sixteen per cent of 
non-promotion, and seventeen per cent of re- 
tardation. The work of medical inspection during 
the last ten years bears out the general truth of 
this estimate. Children with decayed teeth, de- 
fective eyesight, and adenoids, are not likely to be 
either happy or successful. Health in itself may 
not lead directly to happiness, but without it few 
individuals can realize satisfactorily their ambi- 
tions and their better selves, essentials in happi- 
ness. It is not only in school that health helps to 
contribute to happiness and efficiency, but also 
in life after leaving school. The Government and 
an increasingly large number of business firms are 
beginning to appreciate this. Excellent illustra- 
tions are found in the administration of our army 
and navy. Only men who are physically fit are 
accepted, and after they are regularly enrolled 
every means is taken to conserve their health. 

5 



THE TEACHING OF HYGIENE 

Many commercial establishments are beginning 
to understand that the healthy workman is an 
important asset. After a workman has attained 
a certain amount of skill in a manufacturing 
establishment, inability to work means a distinct 
loss to the employer. Many business organiza- 
tions employ physicians to give first aid to the 
injured. Often these workmen are given the 
advantage of baths, gymnasiums, lectures and 
printed matter on hygiene and sanitation. This 
interest in the health of the employed is justified, 
not merely from a humanitarian point of view, 
but from the idea of efficiency in business. What 
has been said of the army and navy and com- 
mercial establishments applies, of course, to all 
society. The prevention of disease makes for 
social progress and happiness. The money which 
society wastes in the cure of preventable disease 
may be diverted into helpful civic and social im- 
provements. 

2. The outlook for the prevention of illness and 
the lengthening of human life 

In the face of such an appalling waste through 

sickness and needless loss of life, there is one 

outstanding truth of conspicuous significance: 

illness is largely preventable and the average 

6 



IMPORTANCE OF HYGIENE 

duration of life may be lengthened. The evi- 
dence bearing upon this is conclusive. The num- 
ber of illnesses is decreasing and the length of 
life is increasing wherever sanitary science and 
preventive medicine are applied. Smallpox, for 
example, which was once the scourge of the civi- 
lized world, has become virtually extinct so that 
comparatively few people to-day have ever seen 
a case. Through recent discoveries in preventive 
medicine, diphtheria has lost its terrors, and 
typhoid is doomed to a similar fate. 

Dr. Fisher believes that it is possible to lengthen 
the average life by fifteen years. Why, then, are 
we not doing more to prevent disease? There are 
numbers of reasons, but the most fundamental 
one is simply popular ignorance of the means. If 
the rank and file of the people really understood 
that we were paying large premiums for prevent- 
able disease, and that prevention is possible and 
much cheaper, we should probably find that more 
money would be spent by municipal, state, and 
national authorities for preventive measures 
and that the citizens would demand that the 
schools give pupils the proper training. 

It takes a long time for society to form a new 
habit. Through the countless centuries of the 
past we have concerned ourselves with the cure of 
7 



HE TEACHING OF HYGIENE 

disease, not with its prevention. The latter aspect 
is so new that few of our medical schools are as 
yet giving respectable courses in hygiene and 
sanitation, and few men are really equipped to 
apply the principles of preventive medicine ; and 
just at present, in spite of an unusual interest in 
health, these men are not in great demand. The 
people must be educated to desire good health 
and for this we must depend largely on our pub- 
lic schools. 

Although boards of public health, hospitals, 
charitable associations, newspapers and maga- 
zines are doing much to enlighten the general 
public; yet all of these attempts appeal almost 
exclusively to adults, the most of whom, being 
called upon rather late in life to adopt a changed 
view in regard to health, find a reformation of 
attitude difficult. We can never expect to ac- 
complish much in cultivating the right kind of 
public opinion toward health control until the 
schools do their part. Although there is a grow- 
ing interest in health matters, that interest is 
still too weak to demand a proper amount of 
money so that health officers can be properly 
paid and trained. 

Splendid as is the work which is being done by 
our municipal boards of health to educate the 
8 



IMPORTANCE OF HYGIENE 

people and protect them, we are just beginning 
to realize that such work has but begun. Franz 
Schneider, Jr. (58), who recently made a survey 
of municipal health departments in the United 
States, in summarizing the results of his investi- 
gation, says: — 

We have seen that at the time of this investiga- 
tion a fifth of the cities made no investigation of 
school-children; over a third did not offer the ordi- 
nary laboratory diagnosis for the commoner com- 
municable diseases; over a fourth made no effort to 
educate in health matters; nearly three fourths had 
no housing law; nineteen twentieths had no concern 
with the hygiene of industry; over six sevenths had 
no program against the venereal diseases; over a 
half had no proper organization to combat infant 
mortality; and less than a quarter had a coherent 
program against tuberculosis. Surely these facts 
argue for a surprising amount of neglected oppor- 
tunity. And when we consider this investigation 
made no effort to determine the efficiency of the work 
attempted, but only whether or not it was attempted; 
and when, with the departments with which we are 
familiar in mind, we reflect on the partial thorough- 
ness with which their slender staffs compel them to 
perform their work, the conclusion becomes inevi- 
table that public health work in this country is still 
in its infancy — certainly as far as application of 
scientific methods is concerned. 



THE TEACHING OF HYGIENE 

One of the striking results of this investigation 
is the showing that the smaller municipalities 
provide less efficient protection of health than 
the larger ones. In the rural districts statistics 
now available would tend to indicate the worst 
conditions. 

3. The relative importance of hygiene in the 
curriculum 

Having recognized the fundamental impor- 
tance of health, we might ask, " What is the rela- 
tive value of the teaching of hygiene in the school 
curriculum? " At the possible risk of being called 
narrow and prejudiced, I wish to state as strongly 
as possible that in view of the foregoing facts 
instruction and training in hygiene seem to be 
more important than any other subject in our 
school curriculum. To read well, to write legibly, 
to calculate accurately, all these and many of the 
other varied accomplishments of the school are 
worth while, but they have a doubtful value un- 
less first of all the pupils are laying the basis for 
good health. Health is important, not as an end 
in itself, but as a means toward practically all 
worthy ends of life. Knowledge and skill gained 
without training in hygiene cannot mean educa- 
tion in the truest sense; for " What doth it profit 
10 



IMPORTANCE OF HYGIENE 

a man to gain the whole world and lose his own 
health?" 

Superintendent Hines with commendable in- 
sight has well said: "The teacher that is well 
trained in matters of hygiene is worth almost 
twice as much to the community as the teacher 
who can attend to the mental needs of her children 
only and who is indifferent to the many conditions 
that bear directly on the health of her charges." 

It is time now to inquire about the efficiency 
of the teaching of hygiene in our elementary 
schools. 



II 

THE STATUS OF THE TEACHING OF 
HYGIENE 

If health education is of first importance in a 
philosophy of education, we might expect to find 
the importance of the teaching of hygiene recog- 
nized in the theory and practice of our elementary 
schools. Let us examine the reports of some typ- 
ical school surveys and other investigations to 
find out what its status is in our public schools. 

i. Reports from surveys and other investigations 

Flexner and Bachman (27) have just submitted 
a report of one hundred and seventy-six pages on 
the educational situation in Maryland. In a 
chapter of twenty-two pages on " Instruction,' ' 
reading, spelling, arithmetic, etc., come in for 
their full share of space. What is said about the 
teaching of hygiene is introduced more or less 
inadvertently in a paragraph on geography. De- 
ploring mere textbook teaching which does not 
consider the environment of the child, the investi- 
gators use two sentences to give their impressions 
12 






STATUS OF TEACHING HYGIENE 

of the teaching of hygiene. They say: " Again in 
physiology, pupils recite about bacteria, first aid, 
and various ailments. Meanwhile they breathe an 
atmosphere filled with the dust just raised by an 
old-fashioned broom, use not infrequently a com- 
mon dipper, and resort to filthy and unsanitary 
outhouses." This stray reference is enough to 
show the failure of the teaching of hygiene. 

The Carnegie Foundation for the Advancement 
of Teaching (63), in its survey of the schools of 
the State of Vermont, does not have the word 
"health" or "hygiene" in its index to a volume 
of two hundred and forty-one pages. It does use 
a half-page to publish a recommendation of the 
State Board of Health on the sanitation of school- 
houses. The whole subject is so little considered 
as to be almost worthless. In the consideration 
of the teaching of school subjects the investigators 
make a comment one sentence long on the teach- 
ing of physiology, not hygiene. It is as follows: 
"No child in a class that was studying the bones 
of the" arms and shoulder by means of a book on 
physiology was able to locate these bones in the 
body." This quotation, short as it is, indicates 
a lack of appreciation of health instruction and 
some sort of belief in the efficacy of time-worn 
instruction in anatomy. 

13 



THE TEACHING OF HYGIENE 

Dr. Frank McMurry (40), in the New York 
School Investigation, found that the instruction 
in hygiene "failed to meet any of the standards 
used." It failed to arouse the interest and initia- 
tive of the pupils and had almost no connection 
with their lives. 

The teaching resolved itself into the teaching 
of physiology, anatomy, alcohol, and narcotics. 
This instruction was given mainly in the upper 
grades, and was left largely to the discretion of 
the individual teacher. 1 

The survey of the schools of Portland, Oregon, 
contributes a splendid chapter on hygiene and 
sanitation. Dr. Terman (22), who made this 
investigation, says that the teaching was not 
"below the average," whatever that means. His 
statements are rather cautious, but they do sug- 
gest that some of the teachers did not appreciate 
the fact that habit formation is the great goal 
of instruction in hygiene. The weakness of the 
teaching is shown in the statement that "Most 
teachers have themselves had little instruction 

1 It should be noted, however, that the director of physical 
training in replying to this criticism said that McMurry had 
not seen the " new course in operation in any of the half 
dozen schools" in the city. See Fifteenth Annual Report of 
the City Superintendent of Schools of the City of New York, 
PP. 538-39- 

14 



STATUS OF TEACHING HYGIENE 

in hygiene and need to have their own scope of 
knowledge enlarged." 

Rapeer (44) who made an investigation of 
educational hygiene in twenty-five leading cities, 
and one who therefore speaks with authority, 
says of the teaching of hygiene : — 

And yet the subject is a tail-end subject, little em- 
phasized, and furnished with poor textbooks for the 
most part, and very frequently with poor teachers in 
the grades and high school. Colleges do not usually 
give credit for nor demand a knowledge of this vitally 
essential subject of health and how to get and main- 
tain it, much to their disparagement, and conse- 
quently we find many schools almost neglecting it. 

Bobbitt (13) found, in the recent survey of the 
Cleveland schools, that, while the school program 
shows that one fifteen-minute period is devoted 
each week to the study of hygiene in the first four 
grades and one thirty-minute period each week 
to the four upper grades, in actual practice the 
subject receives less time than this. The at- 
tempt which was made to find out what was actu- 
ally being done in the classes in hygiene is in- 
teresting. Bobbitt says that "a member of the 
survey staff went on one day to four different 
classrooms at the hour scheduled on the pro- 

15 



THE TEACHING OF HYGIENE 

gram. In two cases the time was given up to 
grammar, in one to arithmetic, and in one to 
music." As a final comment on the teaching of 
hygiene, Bobbitt says: "This represents practice 
that is not unusual. The subject gets pushed off 
by one of the so-called 'essentials.'" 

What teachers themselves consider as most 
important in the curriculum is well shown by a 
survey made of the schools of Chicago by the 
teachers themselves. The report of the survey 
consumes nearly three hundred pages of the 
Sixtieth Annual Report of the Board of Educa- 
tion of the City of Chicago for the year ending 
June 30, 1 9 14; yet the teaching of hygiene is dis- 
missed with seven lines. Reference is made to 
the provisions of the Illinois School Law requir- 
ing " that the nature of alcoholic drinks and other 
narcotics and their effects on the human system 
shall be taught in connection with the various di- 
visions of physiology and hygiene as thoroughly 
as are other branches." Continuing, the report 
says that this topic is placed in the department of 
physical education, that excellent textbooks are 
in use, and that the "requirements of the law are 
fully met." The fact that the schools of Chicago 
are meeting certain legal requirements seems to 
be highly significant in this report 
16 



STATUS OF TEACHING HYGIENE 

The other subjects of the curriculum, such as 
spelling, music, geography, penmanship, art, etc., 
are considered in detail, in the report, as to 
aims, values, and methods, adverse criticism is 
often made and helpful suggestions given, but 
hygiene has scant recognition. One is left very 
much in the dark as to what is considered as 
good teaching in hygiene, and to what extent 
the teaching is successful beyond fulfilling the 
literal requirements of the law. Anything like 
a careful appreciation of hygiene as a school 
subject or enthusiasm in its teaching is not visi- 
ble in the report. 

The investigations referred to so far have had 
in mind the elementary school for the most part. 
The deficiencies in health instruction in the high 
schools are probably more marked than in the 
elementary schools. Small, who has given careful 
thought to health teaching in high schools, says 
that "few schools include health teaching in their 
courses of study." The teacher of physical train- 
ing is perhaps best fitted for such instruction, but 
unfortunately there are few schools that have 
such a teacher, and in most cases he lacks that 
training necessary for a successful teacher of 
hygiene. 



17 



THE TEACHING OF HYGIENE 

2. Hygiene not regarded as fundamental; its 
teaching a failure 

It is fair to assume that the broad investiga- 
tions to which we have referred represent condi- 
tions in the teaching of hygiene that are fairly 
representative of the schools in the United States. 
We are forced to conclude that most educators 
have not yet seriously considered the fundamen- 
tal importance of the teaching of hygiene and that 
the teaching of this subject is largely a failure; 
that it is but little conducive to the getting and 
maintaining of health. 

In justice to the school systems referred to in 
this chapter it should be said that some excel- 
lent health work is being done through medical 
inspection, school nursing, play, athletics, and 
systematic instruction in domestic science. There 
is little evidence, however, that the teacher has 
clearly in mind the contribution that each of these 
activities may make to health or that there is any 
coordination between them and class teaching in 
hygiene. 

The status of the teaching of hygiene may still 

be summed up, as it was a number of years ago 

by Dr. Crampton, who said that "it was a sinister 

fact that most of the teaching of hygiene in our 

18 



STATUS OF TEACHING HYGIENE 

schools is a farce " ; or by Dr. Richard Cabot, who 
in a similar vein referred to hygiene as "the yel- 
low dog among the studies of the curriculum. ,, 

j. Why the teaching of hygiene has failed 

It is perhaps desirable at this time to try to 
find out why the teaching of hygiene has been 
so unprofitable. A careful analysis may suggest 
means as to how these failures may be overcome. 
I should like to suggest the following reasons for 
the inefficient teaching of hygiene. 

(i) The American people do not yet seriously 
appreciate the fundamental importance of health 
for happy and successful living nor the fact that 
health within certain limits is to be gained by the 
proper expenditure of money and by education. 
Until they have this appreciation they are not 
likely to demand that the school regard health 
education as taking the precedence over all 
other school subjects. Reading, writing, and 
arithmetic have been considered so long as fun- 
damental subjects because they were seen to be 
closely connected with the gaining of a livelihood 
and the realization of ambition. The time is not 
far distant when the public will see that hygiene 
has a similar and deeper significance. When we 
remember that during our Civil War the prin- 

19 



THE TEACHING OF HYGIENE 

ciples of antisepsis in surgery was unknown, and 
that there has been a wonderful revolution in 
medical science within the last thirty-five years, 
we ought to marvel that the rank and file of 
humanity have advanced so far. The means that 
are now being taken to popularize hygiene and 
sanitation suggest that society will soon force 
upon the school the responsibility of efficient 
health instruction. The rapid spread of medical 
inspection throughout the country is an index 
also to an awakening public opinion. 

(2) The school itself, as we have already seen, 
has little appreciation of the fundamental im- 
portance of health instruction. In most schools 
pupils are probably not marked in hygiene until 
they reach the upper grades, and it is seldom, 
except perhaps in the higher grades, that hy- 
giene is required for promotion. Not being held 
strictly responsible for results in hygiene as in 
arithmetic, it is easy to see that the teacher will 
often find it convenient to use the time assigned 
to hygiene for arithmetic, music, etc. Even the 
more conscientious teachers, under the pressure 
of supervisors, may yield to such temptations. 
The writer's experience has been something like 
that of Bobbitt at Cleveland. If you go out to 
find instruction in hygiene it is very hard to tree 
20 



STATUS OF TEACHING HYGIENE 

it, and there are abundant excuses as to why it is 
not being taught according to the daily program. 
In all this the teachers are, of course, less to blame 
than the school committee and the supervising 
staff. The responsibility eventually goes back, 
as we have suggested, to the mass of citizens 
themselves. 

(3) The teachers as a class have not been prop- 
erly trained to teach hygiene. A study of "The 
Teaching and Practice of Hygiene in the Public 
Normal Schools of the United States/' under the 
direction of Terman in 19 11 (54), shows that the 
majority of our normal schools are exceedingly 
defective in their training in hygiene. One half 
of the eighty-four normal schools reporting either 
offered no hygiene or none except that which 
came in incidentally in connection with work in 
physiology. Nine schools gave neither hygiene 
nor physiology. Until our normal schools feel the 
need of enlightening our future citizens on such 
important matters, until they feel the call with 
something like religious zeal, the teaching of 
hygiene in our elementary schools will prove 
ineffective. 

(4) Hygiene has so recently appeared in the 
school curriculum that its psychology and peda- 
gogy have not yet been worked out systemati- 

21 



THE TEACHING OF HYGIENE 

cally or satisfactorily. 1 The difficulty of teach- 
ing hygiene rather than arithmetic is easily seen 
if you stop to consider the variety of textbooks, 
devices, and methods which have been pretty 
well worked out in arithmetic and the barren- 
ness of these in the case of hygiene. 

(5) Many of the textbooks still in use devote 
altogether too much space to anatomy and phys- 
iology. Much of the material in these books is 
too difficult for children and is so badly presented 
that it arouses a permanent distaste for the sub- 
ject in the minds of the pupils. Such an attitude 
can hardly be expected to inspire a love for 
health or result in hygienic practices. Many of 
our early textbooks in physiology, the predeces- 
sor of hygiene, were written by physicians who 
believed that anatomy and physiology were of 
prime importance. It has been difficult for us 
to overcome this early impression. There can be 
little doubt that instruction in such matters has 
been barren of result. Cubberley, in a discussion 
of the teaching of hygiene, says: "We have been 
teaching physiology for nearly a half-century 
in our schools, yet of how little practical use it 

1 Freeman's Psychology of the Common Branches (Houghton 
Mifflin Company, 1916), a pioneer work of its kind, omits hy- 
giene from its discussions. 

22 



STATUS OF TEACHING HYGIENE 

has been to us ! . . . We have learned the names 
and number of our bones, the pairs of muscles 
and nerves, and the anatomical construction of 
our different organs, but of practical hygiene we 
have learned but little." Fortunately the old- 
time textbook in physiology is fast disappearing. 
A number of good books on hygiene have re- 
cently appeared that could be put into the hands 
of children with profit. 1 

(6) The hygiene that has been taught has been 
too general and abstract and has aimed at knowl- 
edge rather than health ideals and practice. For 
example, teachers often spend much time on the 
anatomy and physiology of the digestive system 
to the neglect of such vital topics as food values, 
the hygiene of eating, how to preserve food, how 
to keep it from becoming contaminated, the right 
kind of breakfast for children, a good kind of 
lunch to bring to school, etc. 

(7) The instruction in hygiene is not well or- 
ganized or standardized through the grades; 
hence repetition and tedium both for teachers 

1 Among these best textbooks are the series by Gulick 
(Ginn & Co.), O'Shea and Kellogg (The Macmillan Com- 
pany), Coleman (The Macmillian Company), Woods Hutchin- 
son (Houghton Mifflin Company) and Ritchie-Caldwell 
(World Book Company). 

23 



THE TEACHING OF HYGIENE 

and for pupils are common. There is also a com- 
mon neglect of essentials. 

(8) The aims in teaching hygiene have not 
been clearly formulated. Few principals of ele- 
mentary schools have clearly in mind what re- 
sults they ought to get by the time the children 
get through the eighth or ninth grade, conse- 
quently there has been little systematic planning 
for results. They are not able properly to eval- 
uate facts and behavior after they have been 
mastered by the children. 

(9) Hygiene has preached too much and has 
referred too little to facts. Its extreme and un- 
scientific statements have made it an object of 
ridicule and contempt. Fortunately to-day we 
have a large body of reliable facts which, if prop- 
erly presented, may be convincing. 

(10) Few teachers like to teach hygiene. When- 
ever it is possible they "slight" and "dodge" it; 
this is due in part to their not being held up 
rigorously to the standards required in other 
subjects; but it is also a result of indifference to 
the subject itself. It is only natural to expect 
that the general vagueness as to aims, values, and 
methods would tend to dull the natural zeal and 
spontaneity possessed by the teachers. With 
poor training, little comprehension of the social 

24 



STATUS OF TEACHING HYGIENE 

value of what is to be taught, it is little wonder 
that there are failures and that the teaching of 
hygiene is heartily disliked. 

From the foregoing it is clear that our defec- 
tive health instruction in the elementary schools 
is not due to one, but to a large number of factors 
involving deep-seated social prejudices, defective 
training, etc. Interest in health conservation is 
growing at a rate so rapid that there will be a 
constantly increasing pressure brought to bear 
upon the school to give practical health educa- 
tion. How can the teaching of hygiene be im- 
proved? The remainder of this monograph will 
be devoted to the constructive problem, to the 
underlying principles which should govern the 
teaching of hygiene. 



Ill 



THE GOALS OF INSTRUCTION 



i. The acquisition of knowledge 

The most noteworthy aim in education histori- 
cally has been the knowledge aim; it has been 
dominant in education for centuries, and has 
always been conspicuous in the philosophy of 
education. Education has invariably meant 
being literate (literally, having control over the 
symbols of thought). While the great educators 
have always emphasized the importance of get- 
ting the thought from the written or printed 
page, unfortunately this has not always been 
recognized, and so one of the crying evils of every 
age has been the neglect of thought and the as- 
sumption that the mere mechanical command of 
mechanical symbols means education. Not infre- 
quently, too, there has been an emphasis on the 
acquisition of knowledge without relation to its 
being carried out in action, thus serving to adjust 
man to his surroundings or give him mastery 
over them. Knowledge for its own sake has been 
looked upon as cultural, while knowledge designed 
26 



THE GOALS OF INSTRUCTION 

for practical purposes has often been regarded 
as something sordid and unfit for the school. 

The knowledge aim in the teaching of hygiene 
has been and still is in the foreground. Often 
the facts presented have no practical value. 
The early textbooks in physiology were written 
largely by physicians and emphasized anatomy 
and physiology to the almost complete exclusion 
of hygiene. The only topics of a hygienic na- 
ture were those on alcohol and tobacco. The 
need of fresh air, exercise, food, etc., was dealt 
with sparingly. According to the writer's re- 
membrance of his own school days three dis- 
tinctive feats in the teaching of physiology and 
hygiene were thought by the teacher to be highly 
significant. They were as follows: (i) to name 
all the bones of the body; (2) to describe the 
circulation of the blood; and (3) to describe the 
process of digestion. The accomplishment of 
these exercises depended on one's ability to com- 
mit to memory verbatim from the book. There 
were never any thought questions proposed by 
the teacher. The only bit of concrete work in 
connection with these exercises was a dramatic 
performance of dissecting a pig's heart before the 
entire class. This was one of the most interest- 
ing events of the year, but I cannot recall any 

27 



THE TEACHING OF HYGIENE 

suggestions bearing on health. Those who had 
mastered one of the three exercises mentioned 
above were often called upon to demonstrate 
with the aid of charts when visitors were present. 

Such an exhibition may seem to us to-day to 
be senseless; the knowledge given gave no in- 
sight into how one might be healthy, and it is 
questionable whether the knowledge imparted 
made life any richer or better in the case of the 
boys and girls, the majority of whom were soon 
to leave school and go to work. The curious in- 
struction which I have mentioned has in most 
cases disappeared from our public schools, but 
there is still a large amount of subject-matter 
involving physiology and anatomy which ought 
not to be taught to children. 

While it is true that practice is more important 
than knowledge, yet the function of proper knowl- 
edge in promoting action should never be over- 
looked. Whatever may be said in disparagement 
of knowledge, it is nevertheless plain that it helps 
rather than retards the right kind of practice. 

Information acquired by children should be of 
such a character that it may offer possibilities of 
practical value if carried out. Knowledge about 
the carriers of disease, how to control them, and 
how to prevent colds may be really useful. But 
28 



THE GOALS OF INSTRUCTION 

important as personal hygiene is, the health of 
the individual is also dependent upon a scientific 
administration of health affairs. The purity of 
the water, milk, and food supply demands good 
laws, trained health officers, and a sufficient 
amount of money for health purposes. We can- 
not expect efficient administration of health 
affairs until the great mass of voters are intel- 
ligent concerning the fundamentals of public 
hygiene and sanitation. The proper education of 
future citizens in matters of health will do much 
to enlighten public opinion. 

Let us take as a concrete illustration the han- 
dling of food. There is no doubt but that the 
health of the people is greatly endangered by a 
lack of medical inspection of those who handle 
food. The case of typhoid Mary well illustrates 
this. She was a carrier of typhoid and wherever 
she went in the capacity of cook there were out- 
breaks of typhoid. Dr. Cleveland Floyd, of the 
Boston Consumptives Hospital Out-Patient De- 
partment, says that over two per cent of the six 
thousand cases examined in the course of seven 
years were cooks, bakers, waiters, and others en- 
gaged in the handling of food. It was also proved 
that one third of this number were throwing off 
tubercle bacilli in their sputum when they came 
29 



THE TEAGHLNG OF HYGIENE 



- 



to the clinic. Other diseases also, like syphilis 
may also be spread by handlers of food. Until all 
handlers of food are subjected to medical tests, 
we are menaced by a number of disease-carriers. 
When knowledge in regard to this danger is well 
enough known by the great mass of our citizens 
and they are led to feel keenly about it, we shall 
have a law placed on our statute books which will 
offer ample protection from danger from such a 
source. The right kind of knowledge imparted in 
the school, which lays hold of the interests of the 
pupils ought to contribute much toward this end. 

There are certain fundamental knowledge tests 
which every pupil graduating from our public 
elementary schools ought to pass without dif- 
ficulty. To my mind such knowledge is as im- 
portant as a proper command of the mother 
tongue and promotion should be denied those who 
fail in these requirements. I would propose the 
following standards : — 

(i) Ways in which disease is spread. 

(2) What to do in an emergency. 

(3) Common dangers and illnesses and how 
they may be avoided. 

(4) What the immediate community (neigh- 
borhood, town, city), State, and Nation 
are doing to prevent disease. 

30 



THE GOALS OF INSTRUCTION 

(5) How the citizens may cooperate with these 
social and political groups to promote 
hygiene and sanitation. 

(6) The nature and value of foods and drinks. 

(7) The nature of alcohol and tobacco, their 
relation to health (especially to the health 
of children and youth), and the economic 
and social results of their use. 

(8) The names and achievements of the lead- 
ing heroes of preventive medicine. 

2. The formation of health habits 
But knowledge alone is a very unsatisfactory 
goal of education; for we live in a very practical 
world in which we are called upon to work out 
serious problems having to do with happiness 
and efficiency. The mere acquisition of knowl- 
edge is no insurance that the individual will 
carry out his ideas in action. Practically every- 
body who reads these pages is familiar with the 
simple rules of health, but if we come to examine 
our practice we shall in all probability find that 
it is far inferior to our theory. Although knowl- 
edge about hygiene may be pleasurable, yet it 
is inconceivable that such knowledge would ad- 
vance the health of the individual to any appre- 
ciable extent unless it were worked out in practice. 
3 1 



THE TEACHING OF HYGIENE 

One may read about the desirability of taking 
plenty of exercise and thoroughly masticating 
the food, but if one's reaction is not modified as a 
result of this knowledge one is no better off than 
before. The right kind of behavior tending to 
conserve and improve health is of first import- 
ance and takes precedence in its importance 
over all knowledge. 

It is now possible to say, as a result of the fail- 
ures in the teaching of hygiene and from our gen- 
eral observation, that we cannot expect appro- 
priate action unless as teachers we see that pupils 
form the right kind of habits. Pupils may be told 
from a great many points of view that exercise is 
desirable, but practice of this activity is likely to 
be intermittent and finally to cease altogether un- 
less the pupil forms the habit of taking exercise. 
A similar statement might be made of clean- 
ing the teeth, washing the hands, sitting and 
standing correctly, etc. That mere knowledge is 
often futile and that new habits are formed with 
difficulty is, perhaps, a common observation. In 
some of my own classes of normal-school pupils, 
I have frequently asked them to form a habit 
which would seem to them to be worth while and 
then keep a record each day. Even with the in- 
centive of a school mark behind it and the con- 
32 



THE GOALS OF INSTRUCTION 

viction that the habit was worth while, there 
were many lapses, and a simple habit like that of 
masticating the food slowly was not mastered 
until the end of from four to ten weeks. Health 
habits must, then, be the real goal of the teaching 
of hygiene. How they may be formed will be dis- 
cussed later. 

It has already been said that knowledge about 
hygiene is fully as important as knowledge about 
geography or English. If such knowledge is im- 
portant, then how important must the formation 
of health habits be rated. Considering the im- 
portance of health to the individual and society, 
can there be any doubt but that the formation of 
health habits takes precedence over any other 
kind of instruction or training given in the school? 
Any test of the efficiency of the elementary school 
should not neglect the testing of these fundamen- 
tal habits. Just as the real test of arithmetic is 
one's ability, not knowledge, in actually doing 
examples and problems, so the final test in hy- 
giene is a test of habits formed. It is rather sig- 
nificant, as showing the standing of hygiene and 
the formation of health habits, that most sur- 
veys entirely neglect any testing of health habits. 
Charles Hubbard Judd, for example, in his con- 
tribution to the survey of the Cleveland schools, 

33 



THE TEACHING OF HYGIENE 

entitled " Measuring the Work of the Public 
Schools," tested the work done in handwriting, 
spelling, arithmetic, and reading, known tradi- 
tionally as the essentials, and neglected hygiene 
entirely. 

I would recommend that every pupil before 
graduating from the elementary school should 
be required to pass certain fundamental tests 
in habit formation. No promotion should be 
granted without the fulfilling of these require- 
ments. The following classification of habits 
might be suggestive: — 

(i) Personal habits such as cleanliness, care of 
the teeth, manicuring the nails, etc. 

(2) School habits — cleaning shoes before en- 
tering the schoolroom, proper methods of 
erasing blackboards, correct posture, etc. 

(3) Home habits — proper amount of sleep, 
ventilating sleeping-room, etc. Since these 
must be performed in every case without 
the personal supervision of the teacher, 
they are more difficult to perform, but 
much can be done with the cooperation of 
the school nurse and through mothers' and 
parents' meetings. 

(4) Emergency habits — care of bruises, burns, 
etc. 

34 



THE GOALS OF INSTRUCTION 

j. The establishing of ideals 

Health education would be incomplete which 
did not have as one of its aims the establishing 
of ideals conducive to health. The ideal is fre- 
quently conceived of as something purely intel- 
lectual, an ideal of perfection to which the indi- 
vidual may or may not conform, but something 
which he regards with a certain amount of rever- 
ence because it represents that which he would 
be. A mature reader of hygiene once said to me 
that she enjoyed reading hygiene and she had 
certain ideals of personal hygiene, but they never 
seemed to have much effect upon her mode of 
life. This purely intellectual ideal is not what the 
teacher should strive for. The hygienic ideal must 
be an effective ideal, one which finds its expres- 
sion in action. The psychology of the ideal is 
still somewhat obscure, but probably this effec- 
tive ideal to which we refer has its origin in be- 
havior rather than in ideas. If one forms the 
habit of cleaning his teeth regularly before going 
to bed at night, he is likely to have a mental con- 
cept of a correct hygienic practice, but it is a 
concept connected with real action. But I feel 
quite sure from my own observation, and from 
inquiries made in connection with my class- work 

35 



THE TEACHING OF HYGIENE 

as a teacher of hygiene, that comparatively few 
people who clean their teeth in the morning and 
who also appreciate the importance of cleaning 
their teeth before retiring at night actually clean 
their teeth then. These people really have two 
ideals, one purely intellectual and ineffective, the 
other intellectual and effective. The effective 
ideal, the only one worth mentioning, seems to 
have its source in the action of pupils. Such ideals 
are not only important for personal hygiene, but 
helpful in cultivating social and public health 
ideals. For example, if children are informed 
as to the dangers in handling food and have 
themselves formed proper habits, they are likely 
to have a helpful attitude toward the public 
methods of handling food. 

It is believed by many teachers that the recit- 
ing by children of words pledging allegiance to 
the flag helps to cultivate a spirit of loyalty and 
an ideal of American citizenship. Some good 
teachers of hygiene also believe that the com- 
mitting to memory and the recital of a carefully 
worded health creed is of noteworthy assistance 
in inspiring effective hygienic ideals. Probably 
this is true in some measure; one of the possible 
dangers, however, in the teacher's use of the 
creed is an overestimation of what it does for 

36 



THE GOALS OF INSTRUCTION 

the pupil. A properly worded creed recited by 
the school will help to keep before the children 
the principles toward which they are working ; it 
may arouse some real enthusiasm and have some 
influence on action; but the teacher who depends 
largely on such a support for her work will 
encounter failure. Training cannot be accom- 
plished so easily. The teacher who is skillful in 
imparting information and in giving the right 
kind of training may find that the recital of a 
creed will prove of some help in the cultivation of 
an effective health ideal. 

The Massachusetts State Board of Health has 
recently published and distributed a health 
creed for the boys and girls of the State which is 
to be recommended if it seems to be desirable to 
use one. It runs as follows: — 

MY BODY IS THE TEMPLE OF MY SOUL 

Therefore : — 

I will keep my body clean within and without; 

I will breathe pure air and I will live in the sun- 
light; 

I will do no act that might endanger the health 
of others; 

I will try to learn and practice the rules of healthy 
living; 

37 



THE TEACHING OF HYGIENE 

I will work and rest and play at the right time and 
in the right way, so that my mind will be strong 
and my body healthy and so I will lead a useful 
life and be an honor to my parents, to my friends 
and to my country. 



IV 

SUGGESTIONS ON METHOD 

Success in the teaching of hygiene cannot be 
expected if the instruction and training are 
limited to a few minutes of daily class- work. The 
formation of effective health ideals and habits 
involves every attitude of mind and every mode 
of behavior both inside and outside of school. In 
the remainder of this monograph the teaching of 
hygiene will refer not only to class instruction, 
but to all the means, both incidental and sys- 
tematic, whereby the teacher may further the 
health of the pupil. 

Let us consider next some of the methods of 
realizing this end. 

j. Health as a motive ineffective 

The teacher who has clearly in mind the rea- 
sons why she is teaching hygiene has mastered 
the first essential step in successful methods; for 
no amount of knowledge of subject-matter and 
sympathy with child life, no amount of enthus- 
iasm, will be likely to lead to practical results un- 

39 



THE TEACHING OF HYGIENE 

less she is guided by distinct purposes. But such 
purposes are not likely to be attained unless there 
is, in the second place, a deep sympathy with 
the interests and ambitions of childhood. Some 
school subjects are fortunate enough to be so in- 
teresting in themselves that the teaching is nat- 
urally more easy. The study of the life history of 
the common insects appeals at once to children 
so strongly that failures in teaching such les- 
sons must be due to the inability of the teacher 
to use the spontaneous interest of the pupils. 
Lack of interest often results from foisting upon 
the pupils facts that are dry and bookish. 

What is the child's attitude toward health? 
Dr. Wood (58) refers to an investigation made in 
the Speyer School and in a fourth grade in a New 
York City East Side boys' school. In each grade 
questions bearing upon the subject of health, its 
meaning, means of attaining it, etc., were asked. 
In the first four grades of the Speyer School the 
questions were put orally and to individual chil- 
dren and in the other grades the answers were 
written and names were not put on the papers. 
By such methods the children were given free- 
dom of expression and were not influenced by 
the answers of others. Being healthy meant to 
a good many "feeling well," "strong," "bright," 
40 



SUGGESTIONS ON METHOD 

"lively," "feel like doing things/' etc. In reply 
to the question as to why they wanted to be 
healthy, many gave answers like these: " So I can 
play and go to school," " to be out of doors," " to 
be able to see friends," "to romp in the park," 
and "to chase with my dog." 

In summarizing this investigation Dr. Wood 
says: "In no answer is there any suggestion that 
the child is interested in health in the abstract 
or as a future beneficial state. His sole health 
concern exists in application and relation to the 
immediate present. Interest in growing well and 
strong is nowhere indicated save as this state 
gives increased power and capacity for present 
enjoyment." 

The child, then, has only a vague appreciation 
of the meaning of health. He lives in a world 
palpitating with the joys of present-day living. 
To-morrow and the days that follow have only 
a shadow interest compared to the zests of the 
present. To tell Johnny that he must get plenty 
of fresh air so that he may have strong lungs and 
avoid tuberculosis is useless. The idea of health 
is no motive to action. What may happen in the 
years to come cannot be understood and is dis- 
regarded. Dr. G. Stanley Hall has put the mat- 
ter neatly by saying: "To tell a child that Irving 

4i 



THE TEACHING OF HYGIENE 

Fisher has found that by conforming to certain 
well-established laws of health, life may be pro- 
longed on the average fifteen years seems a far 
cry, and is ineffective, for the child is absorbed 
in living out all the possibilities of the present 
reality." 

2. Some motives that will work 

The apparently direct motive of health proving 
unsatisfactory, other means must be depended 
upon to realize those goals of health education 
presented in this monograph. This must be done 
by associating the knowledge which is to be im- 
parted and the habits which are to be established 
with the natural or acquired interests of the chil- 
dren. Many illustrations of this procedure will 
be given later. Here we refer to only a few. The 
failure of instruction in knowledge has already 
been pointed out. In the past there has been a 
lack of concreteness and a remoteness of attach- 
ment to the interest of childhood that has proved 
disastrous to health education. Descriptions, for 
example, of the structure and functions of the 
interior parts of the body, which the pupils have 
never seen or have little interest to know about, 
have tended to make physiology and hygiene 
dry, uninteresting, and often disgusting to chil- 
42 



SUGGESTIONS OxN METHOD 

dren. Assuming that the facts to be presented are 
of recognized worth, they should be presented 
so as to ally themselves with some interest 
already present. Just at present, for example, 
there is an unusual interest in the great Euro- 
pean War. In every town and city men have 
been called to the colors. Their call and depart- 
ure have made a profound impression upon the 
children. Here is a chance to drive home some 
splendid information on health. What does the 
United States Government do for the health of 
the soldiers? Current newspapers and magazines 
and even letters written from the front throw 
light upon this. Regulations concerning the 
covering of food to protect from insects, the 
draining of camp-grounds, the destruction of 
mosquitoes and flies, and general cleanliness, — 
all these and many others, supplemented by 
illustrations from newspapers and magazines, 
would offer material for several excellent lessons; 
lessons that would be accepted eagerly by the 
children. Then, too, children have a genuine 
interest in the heroic. The history of preven- 
tive medicine tells eloquently of many men who 
offered their lives to further the cause of health. 
If the teacher seizes these dramatic events, con- 
nects them with some personality, and tells the 

43 



THE TEACHING OF HYGIENE 

story well, the children will grasp much valu- 
able information with interest and ease. The 
story of the life of Dr. Trudeau illustrates this 
point beautifully. A man with a brilliant future, 
he found himself in the loathsome grip of tuber- 
culosis. Invading the wilds and leaving his family 
behind, he fought a long fight to recover his own 
health, met with success, established the first 
fresh- air sanitarium for consumptives in America, 
and gave to the world a scientific program for the 
cure and prevention of tuberculosis. The learn- 
ing of the scientific facts concerning the nature, 
prevention, and cure of tuberculosis would be 
far from interesting to children generally, but 
told in connection with the stirring events of 
Dr.Trudeau's life they take on a peculiar charm. 
The first steps in the formation of hygienic 
habits are usually far from being interesting. 
They are extremely distasteful to children. A 
common complaint of both children and adults is, 
"It's too much trouble." Yet the most uninter- 
esting hygienic habit may be practiced with a 
good deal of eagerness. Children ordinarily do 
not care about posture in relation to health. They 
slouch down in their seats because it has become 
habitual or seems to be more comfortable. They 
fail to understand why the teacher should be con- 
44 



SUGGESTIONS ON METHOD 

tinually nagging them about the way they stand, 
and when told that a bad standing posture in- 
terferes with proper breathing and encourages 
lung trouble they only smile. But suppose, on the 
other hand, the children are told how well one 
looks when he stands erect and sits correctly. 
Suppose those who have good posture are given 
the preference at the head of a marching line. 
The child is now impelled by the spirit of pride 
and competition to form the right habits. Many 
of the hygienic habits may be established with 
little reference to health. 

One of the deepest impulses of child nature is 
the impulse to act. Outside of school the child 
spends practically all his time in doing some- 
thing. This same impulse may be directed with 
profit in the teaching of hygiene. Many of the 
activities connected with good health may be 
dramatized. The thing itself may not be of in- 
terest, but there is always great interest in the 
doing. The ordinary accidents and the cor- 
responding emergency treatment may well be 
acted out. One school known to the writer did 
some excellent work in writing little plays pre- 
senting accidents and emergencies. These plays 
were submitted to a committee and the best ones 
were finally acted out by the pupils with great 

45 



THE TEACHING OF HYGIENE 

zest to the advantage of both English and hy- 
giene. 

3. The psychology of habit formation 

The importance of desirable modes of be- 
havior or hygienic habits has been emphasized. 
The establishing of these habits is the most im- 
portant and at the same time the most difficult 
problem in the teaching of hygiene. It is a com- 
mon assumption on the part of teachers that 
a good deal of talking to children about the 
desirability of establishing hygienic habits will 
speedily lead to their formation. Such an as- 
sumption, however, does not seem to square with 
practice. It is quite probable that merely talking 
about the formation of habits is a waste of time 
in ninety-nine per cent of the cases. The principal 
reason for this is that every habit which is to 
be formed involves the making of new connec- 
tions in the nervous systems. These connec- 
tions are not established by simply knowing that 
they ought to be made but by actually practic- 
ing the habit until it becomes automatic. To 
learn to masticate the food properly one must 
chew the food well and continue to do this until 
the act is performed mechanically. It is only 
by such repetition that the necessary connec- 
46 



SUGGESTIONS ON METHOD 

tions or pathways, as James calls them, are 
formed. 

Moreover, mere verbal exhortation seldom 
gives the individual the initiative needed to im- 
pel him to carry out his resolution often enough 
for the new habit to be really formed. Often, too, 
such exhortation instead of furthering the devel- 
opment of the habit arouses a spirit of antago- 
nism which is fatal to the desired result. In get- 
ting children to form habits the first essential is 
to present clearly the habit which is to be formed. 
Such explanations should be given simply and di- 
rectly. Washing the hands after coming from the 
toilet and before meals is one of prime importance 
to health. These ideas may be presented in talks 
to the pupils, but such ideas alone would prob- 
ably be ineffective. Motives must be given which 
will lead the pupils to desire to form the habit of 
keeping the hands clean. Particularly in the case 
of little children there would be no appreciation 
from a health standpoint of having clean hands. 
Another incentive must be found. One teacher 
known to the writer divided her school into two 
divisions, one having the name Harvard, the other 
Yale. They were supposed to be competing teams. 
The goal was to have the cleanest hands. Every 
morning the hands were inspected and the record 

47 



THE TEACHING OF HYGIENE 

of dirty hands was placed on the blackboard. 
The interest was genuine, and those who were 
negligent were promptly prodded by their com- 
panions. 

The crucial point in all habit formation is the 
possibility of a lapse in the practice of the habit 
before it has become mechanical. Every time 
one slides back into the old habits the formation 
of the new habit is retarded and even prevented. 
To prevent such lapses, the teacher must follow 
them up whenever possible to see that no excep- 
tions occur. The daily inspection of teeth, hands, 
and nails is an essential factor in personal hygiene. 

Before attempting to urge pupils to form a 
particular habit the teacher should see that it is 
physically possible to form the habit. For exam- 
ple, if there is a muddy school yard and no foot- 
scraper or mat or broom, we must expect that 
dirt will be tracked in. Before drilling pupils on 
this habit these things should first be provided. 
This does not always mean that the matter must 
be referred to the school authorities. A foot- 
scraper in some cases might be made by helpful 
pupils. Again, if there is no water, towels, or 
soap, it will be impossible for pupils to practice 
in school the art of keeping the hands clean. In 
time an intelligent public opinion will make 
4 S 



SUGGESTIONS ON METHOD 

such a situation intolerable, but at present the 
teacher's ingenuity must be taxed to solve the 
problem. 

Finally, the teacher must see that the practice 
of the habit brings satisfaction. The importance 
of this has been shown many times in the lit- 
erature of psychology. An animal picks its way 
through a maze because that particular route 
leads to food; the crude, instinctive movements 
of a cat confined in a cage give way to a definite 
mode of reaction, a habit, as soon as a chance 
movement is successful; children repeat untruths 
when they find that they help them to gain their 
ends. The teacher who is skillful enough to make 
the practice of a desirable habit pleasurable to 
the child and the opposite kind of reaction pain- 
ful is bound to be rewarded with success. The 
teacher's approval and praise often greatly in- 
fluence the repetition of a given act, and likewise 
the sting of her disapproval of an undesirable act 
may prevent its reappearance. 

4. Habits to be formed and to be avoided 

Standards of habit formation for pupils in the 
elementary school have already been presented, 
but a brief enumeration of some of the detailed 
habits necessary for health might be helpful. 

49 



THE TEACHING OF HYGIENE 

These are some of the habits that teachers should 
strive to get pupils to form: — 

(i) Cleanliness of body, especially the hands, 
and cleanliness in the schoolhouse and on the 
school-grounds; (2) cleaning the teeth; (3) cor- 
rect sitting and standing postures; (4) correct 
breathing; (5) correct use of the voice; (6) right 
use of the eyes; (7) care of hair and nails; (8) use 
of individual drinking-cups, pencils, and other 
materials; (9) use of the handkerchief; (10) move- 
ment of the bowels daily; (11) exercise and play 
in the open air every day; (12) cheerfulness, par- 
ticularly at meal- time; (13) chewing food slowly; 
(14) drinking plenty of water; (15) ventilating 
the schoolroom; (16) cleaning shoes before enter- 
ing the schoolroom; (17) dusting school furni- 
ture; (18) cleaning blackboards; (19) sleeping 
with windows of sleeping-room partially open. 

There are also some habits which should be 
discouraged; such as (1) putting things into the 
mouth; (2) expectorating on the floor; (3) biting 
nails; (4) thumb-sucking; (5) " swapping" gum, 
food, etc.; (6) coughing in another's face; (7) 
kissing on the lips; (8) carrying soiled handker- 
chiefs; (9) picking the nose; (10) licking the fin- 
gers in turning the pages of a book; (11) reading 
in a dim light; (12) rubbing the eyes; (13) putting 

5o 



SUGGESTIONS ON METHOD 

foreign bodies into the ear; (14) cracking nuts 
with the teeth; (15) overeating; (16) eating when 
tired; (17) using another person's brush, comb, 
towel, drinking-cup; (18) wearing wet clothing; 
(19) bandaging a cut with a dirty cloth; (20) 
wearing shoes that are too small or that have high 
heels; (21) negligence in bathing; (22) bad pos- 
ture; (23) worry; (24) use of tobacco, alcohol, and 
narcotics; (25) leaving food exposed to flies; (26) 
having no regular time for exercise. 

5. Give marks for habits formed 

The abuse of school marks is notorious, but all 
educators are practically agreed that they are a 
necessity. Besides being useful in the administra- 
tion of the schools, it cannot be doubted that 
they are incentives to children and that the mark- 
ing of any particular thing gives it an added im- 
portance in the eyes of the children. The funda- 
mental importance of the health habits necessi- 
tates their being marked as well as the intellectual 
attainment in hygiene. Consider the inconsis- 
tency of marking a child on knowledge about the 
teeth and their care and not giving any mark 
for keeping the teeth clean, the thing of greatest 
importance. 



5* 



THE TEACHING OF HYGIENE 

6. Special honors for hygienic living 

Giving marks for hygienic living is one way to 
stimulate right living, but there are other ways of 
impressing children and parents with a sense of 
its importance. In many schools special honors 
are conferred upon those who have done superior 
work in particular school branches. Where this 
is common, hygiene should not be neglected, but 
in every case such honors should be given for 
actual observation of the rules of health. This is 
so important that it might be desirable to offer 
honors in hygiene even if it were not common in 
the other work of the school. In the Bowdoin 
School of Boston those pupils who have been 
exceptional in healthful living have had stars 
placed after their names on the commencement 
program, with this explanatory note at the bot- 
tom of the page, " excellent in maintaining ideals 
in hygiene.' ' 

E. A. Hines (35), tells an interesting story of 
the results of a reward system in the teaching of 
hygiene. When a health officer in Seneca, South 
Carolina, a town of 13 13 population, he noticed 
that the schools were often obliged to close be- 
cause of transmissible diseases. It occurred to him 
that the health of the pupils would be materially 
52 






SUGGESTIONS ON METHOD 

promoted if a premium could be placed success- 
fully on simple cleanliness and the observance of 
the basic principles of hygienic living. In 1904 
he offered a gold medal to the child who had 
demonstrated to the satisfaction of the faculty 
that he had carefully practiced the principles of 
cleanliness in person and apparel and had at- 
tained good marks in general scholarship. This 
innovation naturally attracted the attention, not 
only of the children and parents, but the com- 
munity at large. As a result Hines says that the 
entire student body took a pride in personal 
hygiene and school sanitation, transmissible dis- 
eases were reduced, and the general sanitation in 
the community was greatly improved. It might 
not be desirable to try this same plan in every 
community, but the principle involved is peda- 
gogically sound, to confer special honors upon 
those who practice the laws of health. To allow 
only those who have clean hands the privilege of 
passing materials in school is to follow out the 
same idea. 

7. Training in habit formation in school 

The necessity of following up activities until 
they are finally rooted as habits bristles with dif- 
ficulties, since the number of hours that the chJl- 

53 



THE TEACHING OF HYGIENE 

dren are under the direct supervision of the 
teacher is limited. Therefore, the time spent in 
the schoolroom should be utilized to the fullest 
extent to see that habits are really formed. Daily 
inspection by the teacher will do much to help 
children to form habits. Hands, nails, and teeth 
may be inspected in this way. Training is also 
possible in connection with posture, ventilation, 
adjustment of window shades, correct use of the 
eyes, use of individual material, etc. Through the 
cooperation of medical inspector, nurse, and par- 
ents much may also be done, as we shall point 
out in detail, to establish these habits and others 
as well. 

8. Methods of getting children to form habits 
outside of school 

Since health is connected with all the activities 
of life, no kind of health education is likely to be 
very effective which does not influence the forma- 
tion of habits outside of the school. One plan 
which has been tried effectively by Alderman (i), 
not only in hygiene, but in other subjects, is to 
assign home duties and give the child a certain 
amount of credit for the work done. This may 
be checked by getting the parent to certify to it 
in writing. Before assigning duties to children it 
54 



SUGGESTIONS ON METHOD 

is desirable to know something about their home 
life so that duties may not be assigned which 
have already become habitual. The teacher's 
health survey, referred to a little later, may be 
useful here. Credit might properly be given for 
playing a given length of time in the open air. 

One method which is being used in a few schools 
is to get the child to keep an accurate record of 
certain hygienic activities, such as the number of 
times the teeth were cleaned, baths were taken, 
etc. This method is psychologically sound, be- 
cause, unless the child is made to feel some sort 
of responsibility for hygienic practices and has 
something to remind him, habits will not be 
formed. Benjamin Franklin tried this method to 
arrive at moral perfection. He wished to gain 
habits of silence, temperance, order, resolution, 
frugality, industry, sincerity, justice, modera- 
tion, cleanliness, tranquillity, chastity, and hu- 
mility. He believed that mere speculative con- 
viction about these habits would not insure their 
being formed, so to prevent what he called "slip- 
ping" he copied these words in his notebook and 
arranged it so that he could make a record for 
each day by simply marking the rule which he 
had broken. It was his hope some day to look 
upon a clean sheet. 

55 



THE TEACHING OF HYGIENE 

Edward F. Brown (i i) of the Bureau of Welfare 
of School Children, New York City, outlines with 
great care a similar scheme to train children to 
form hygienic habits. To make his proposal con- 
crete he suggests that a blank be planned for chil- 
dren approximately ten years of age as follows: 



DAILY HEALTH EFFICIENCY RECORD 



Name. 
Date.. 



Health Habits 

i. Rise at seven o'clock 

2. Toilet 

3. Bathe daily, if possible. Otherwise every 
other day 

4. Brush teeth and gums. Wash mouth 

5. Exercise for five minutes 

6. Clean, comb, and brush hair 

7. Dress lightly in summer; warm in winter. . . 

8. Eat breakfast. A good breakfast consists of 
cereal (eggs if possible), milk, bread and 
butter (State what you had.) 

9. If weather and distance permit, walk to 
school 

10. Eat lunch. Don't eat if overheated or ex- 
cited. All meals should be eaten slowly and 
food chewed well. A good lunch consists of 
hot soup or broth, meat, vegetable, if pos- 
sible, and bread 

56 



Yes No 



SUGGESTIONS ON METHOD 

Yes No 
n. After school play outdoors, if possible, for 
two hours 

12. Eat light supper 

13. Before retiring brush teeth and gums well 

14. Sleep for ten hours 

15. Keep windows of sleeping room open all 
night 

I declare that 

I observed of the rules of 

health. 
Observing all rules is Excellent. 
Observing 13 rules is Good. 
Observing n rules is Fair. 
Observing less than 1 1 rules is in the danger 

zone. 

It is Brown's idea that one of the first of the 
morning tasks should be to distribute to each 
child a blank form. The children should then be 
instructed to fill out the blank for the previous 
day's activities. The children should be expected 
to rate their own conduct on the basis of the 
standard rating. It is too much to expect that 
there will be no falsification, but such a system 
will probably help those who have a tendency to 
be untruthful. There will always be a substantial 
majority in the class that will be truthful and 
will profit from this method. Brown suggests 
that in the case of the older children there may be 
57 



THE TEACHING OF HYGIENE 

some graphic representation of the ratings. This 
plan encourages the pupil to maintain and better 
his record. 

While there might be some criticism of the de- 
tailed plan submitted by Brown for children ten 
years of age, there is much to commend it. It is 
not only likely to further habit formation of the 
right kind, but it may give the teacher, school 
nurse, and medical inspector valuable informa- 
tion about the individual children. Even if the 
expense makes the printing or duplicating of the 
blanks impossible, every teacher might plan a 
form of her own, on paper properly ruled, have 
the pupils copy it, and then make out the daily 
report in the regular way. 

g. Study the health of your pupils 

The successful teacher of hygiene will realize 
that the children must not only conserve what 
health they have, but that they ought to im- 
prove their health while in school. This cannot 
be done in a general way; the teacher must use 
individual methods. She must be familiar with 
the physical condition of her pupils first of all 
and this means a study of every individual in the 
school. Whether there is medical inspection of 
the pupils or not is immaterial. Such a study not 

58 



SUGGESTIONS ON METHOD 

only prepares the way for an intelligent attitude 
on the part of the teacher toward the pupils' 
health, but it also gives her an insight frequently 
into the conditions involved in the learning of 
the children. Dr. Hoag, in his splendid campaign 
in school hygiene in Minnesota, suggests a num- 
ber of questions which a teacher might ask chil- 
dren to get a survey of the health of the children. 
The abbreviated form is given below: — 

ABBREVIATED CARD FORM OF A 
TEACHERS' HEALTH SURVEY OF THE 
SCHOOL CHILD 

Name School 

Grade Age 

Date 

i. Have you ever been in a grade more than one year? 

2. Have you ever had any serious sickness? 

3. Do you feel strong and well now? 

4. Do you eat breakfast every day? 

5. Do you eat a noon meal every day? 

6. Do you drink coffee? 

7. Do you always have your bedroom window open at 
night? 

8. Have you been to a dentist within a year? 

9. Do you have toothache often? 

10. Do you own a toothbrush? 

11. Do you use your toothbrush every day? 

12. Do you have a toothbrush of your own? 

59 



THE TEACHING OF HYGIENE 

13. Do you have much trouble with headache? 

14. Can you read writing on the blackboard from your 
seat? 

1 5. Does the print in your books run together or look dim 
or crooked? 

16. Do your eyes hurt after reading a good while? 

1 7. Do you sometimes see two letters or two lines instead 
of one? 

18. Do you often have earache? 

19. Do your ears ever run? 

20. Can you always hear the teacher? 

21. Do you go to bed by nine o'clock? 

22. Do you go to bed by ten o'clock? 

23. Do you bathe at least once every week? 

24. Have you ever been vaccinated? 

25. Have you ever had smallpox? 



Remarks. 



This child has had the following diseases at the age 
indicated below: — 

Chickenpox when Whooping-cough when 

years old. years old. 

Diphtheria Pneumonia 

Measles Typhoid fever 

Tonsillitis Smallpox 

Mumps Tuberculosis 

Scarlet fever Infantile paralysis 

The survey should not be made until the 

teacher has had a chance to get acquainted with 

her pupils. The teacher should ask the questions 

of each individual pupil and record the answers. 

60 



SUGGESTIOxNS ON METHOD 

Care should be taken that every question is un- 
derstood. If there is any doubt, test the pupils 
by putting the question in a different form. 
Dr. Hoag (34) believes that a careful survey by the 
teacher will reveal ninety per cent of the physi- 
cal defects. If the school is visited regularly by the 
school physician the teacher may refer to him pu- 
pils that have serious physical defects, and after- 
wards try to cooperate with the home. If there is 
no medical inspector or school nurse, the teacher 
in some cases may get the parent to take children 
to some local physician. When certain defects — 
like eye defects, for example — are discovered, 
the teacher may at least do something to relieve 
the physical strain and facilitate the child's learn- 
ing, if it is no more than to give the child a favor- 
able seat. Then, too, if the teacher has some in- 
sight into the child's physical condition and mode 
of life, she will know what habits in particular 
ought to be formed and then take measures to 
see that they are inculcated. 1 

1 For further suggestions concerning the teacher's health 
survey the teacher may consult Hoag and Terman: Health 
Work in the Schools. (Boston: Houghton MifBin Company, 
1914, pp. 62-89.) Ernest Bryant Hoag, Organized Health 
Work in Schools. (United States Bureau of Education Bulletin, 
1913, no. 44.) 



61 



THE TEACHING OF HYGIENE 

10. Cooperate with medical inspector 

After this careful survey of each pupil's health 
the teacher will know something about the most 
of the individual problems with which she must 
cope. If there is a regular medical inspector this 
work will be of the greatest assistance. In many 
schools the medical inspector visits the schools 
rather infrequently, and his time is so limited that 
often he merely inspects those pupils that are 
referred to him by the teacher. Consequently 
the success of the medical inspector is in large 
measure dependent on that of the teacher. If, 
for example, the teacher fails to notice symptoms 
of illness the cooperation of the medical inspector, 
which would often mean the prevention of an 
epidemic, would in most cases be impossible. 

ii. Get cooperation of parents 

Even after the teacher's health survey and 
after her judgment has been strengthened by that 
of the medical inspector, the solution of the prob- 
lem will often be unsolved unless the parent is 
sympathetic. Many children are disorderly in 
school and take no interest in their lessons be- 
cause of acute eye-strain. If such a pupil can be 
supplied with glasses it may change the whole 
62 



SUGGESTIONS ON METHOD 

current of that boy's or girl's life and greatly im- 
prove the conditions for the work of the other 
pupils of the school. The teacher who can solve 
§uch a problem confers an everlasting benefit 
upon the pupil, the school, and the community. 

]| the school authorities have set aside a fund for 
the purchase of glasses the matter is soon solved ; 
but unfortunately this is rare. The first respon- 
sibility for such an expenditure is with the par- 
ents, but should they prove to be too poor or 
obstinate Ihere is difficulty. Sometimes, if a no- 
tice of the needs of the child, sent out by the 
teacher or medical inspector is Ignored, a frank 

talk with the parents will adjust the matter 
quickly. The cultivation of understanding and 
sympathy between parents and teachers is often 
a, result of parent teai her associations. When a. 1 1 
such efforts with the parents meet with failure, 
money can sometimes be secured by appealing to 
sonic charitable association. 'Hie chief objection 

of parents is usually a. financial one. In some 
cases, where the expenditure of money is not 
involved, but where the out of < hool life of the 
pupil must be regulated, the cooperation of the 

parents is essential. The ana-niic pupil, for ex- 
ample, should sleep with his window open, get 
plenty of fresh air during the day, and also the 
63 



VUF RACKING OF HYGIENE 

M tactful and persistent 
lit results. In every 
case - the pupil's health is defective CM 

v must be found to follow 
ft sort ol oversight over 
.til the p (L This sort of 

. d by a 9Chool nurse. 
A- in Qhist 

be from the 
.. Worcester 
- 

rj 

11.. . lie, under- 

pe which left 
.. weakened condition. 

At the :. of the medical in- 



/^*nt wa* made wherdvy he was lent 

V, \:.f. './/.:.♦.'/ \'.t '■:.'. •" '" ' 

:.; : . <./<- v-'.-. .'. v ;',."., '.',..'.;< /'//. / v/ '. '>...., 

MtrtwhfA amtereace»withthemod*i f fhebcy 

and is doing food work. 
This is a kind of work in hygiene that count* . 

; ' • ........... 

intervals a board of health which will hare gen- 

eral oversight over window ventilation, tempera- 

re, etc., of the r ^-organized health 



THE TEACHING OF HYGIENE 

fly, do away with stagnant water, screen out- 
houses, etc. Interest is sometimes aroused by 
securing buttons with the words " Health Club," 
or some other symbol upon it, for members of the 
organization. In Kansas City, Missouri, health 
clubs are suggested in the course of study as 
early as the fourth grade. Classes are to be or- 
ganized into "Good Health Clubs" at the begin- 
ning of the year, selecting their own officers, such 
as president, secretary, and an inspector for such 
groups of children as the teachers may deem wise 
to form. Pupils are also to keep a written record 
of their hygienic practices. These records are 
inspected as a part of the work of the Good 
Health Club. 

The health clubs if successful are not only 
valuable because they lead the pupils to apply 
the knowledge which they have gained and aid 
in habit formation, but they help to develop 
initiative and individual responsibility, necessary 
qualities of good citizenship. 

ij. Planning the course of study 

To attain the standards suggested in this mono- 
graph there must be a careful and systematic 
organization of the course of study through the 
various grades, so that plans may be made for 
66 



SUGGESTIONS ON METHOD 

the acquisition of certain knowledge and the 
establishment of definite habits. It is only in 
this way that results of a permanent value may 
be expected at the close of the elementary-school 
period. The course of study (pp. 68-72) , suggested 
for the fourth grade by a committee of Boston 
teachers, including the author, illustrates the 
writer's point of view. It is arranged so that 
the teacher may see at a glance just what know- 
ledge the children are supposed to gain and what 
habits it is intended to encourage. The most 
important habits, which the teacher is expected 
to follow up vigorously, are printed in bold-faced 
type. The suggestion to " keep teeth clean" is 
also capitalized as it is to have special emphasis 
during the year. 

14. The plan of work in the first four grades 

One source of the failure of the teaching of 
hygiene is the assumption of teachers that pupils 
must always know the reason why they are to do 
things. Acting on this principle the result has 
been that the child has usually been taught a good 
deal of physiology and anatomy, but he has been 
left in a muddled state of mind as to the why and 
with no tendency to act in the right way. The 
teaching of little children demands only the 

67 



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SUGGESTIONS ON METHOD 

simplest of explanations, those that can readily be 
understood. Instead of instructing the child con- 
cerning the process of digestion and showing him 
pictures of the drunkard's stomach, the child can 
be told that business houses, railroads, athletic 
teams, and police departments have no use for 
the habitual drinker. As we have already pointed 
out, the main thing is to get the child to form the 
right kind of habits. Habit formation rather than 
the acquiring of knowledge should be the great 
goal in the first four grades. Much of this in- 
struction can and should be given incidentally as 
it is needed. To the boy who cuts his finger, and 
to his interested companions as well, can be 
given a very useful lesson on bandaging and how 
to prevent infection. Although all opportunities 
should be utilized to teach hygiene incidentally, 
a certain amount of time should be definitely set 
aside on the program for instruction and inspec- 
tion. Lessons should ordinarily be oral, simple, 
direct, and practical. Often this instruction can 
be given by telling a story like Laura Richards 's 
"The Pig Brother. " Little physiology and anat- 
omy should be taught except as it is likely to sup- 
port the habits that are to be formed. 



73 



THE TEACHING OF HYGIENE 

15. The plan of the work in Grades V to VIII 

The effort to get children to form hygienic 
habits should not be relaxed in the upper grades, 
although it is to be hoped that if the work in the 
lower grades has been done well less constant 
drill will be necessary. For example, if a child has 
formed the habit of brushing his teeth before he 
reaches the fifth grade, then little needs to be done 
except to see that he does not lapse in his habits. 
Whenever the necessary hygienic habits have not 
been formed, — and a great many of them will 
not have been acquired, — the efforts of the 
teacher must be continued. But in the upper 
grades the child should get more and more in- 
formation which will give him a broader outlook 
as to the value of health to the individual and 
society, and also information which will tend to 
support the habits which he has or may be form- 
ing. More subject-matter in physiology and 
anatomy may now be introduced, but it should 
be carefully selected with a view to its illumina- 
tion of some vital health problem. 

In these grades particular emphasis needs to 

be put on the citizen's relation to health and 

sanitation. Several good textbooks are now on 

the market. Hutchinson's Community Hygiene 

74 



SUGGESTIONS ON METHOD 

(Houghton Mifflin Company), is a sample of the 
kind of book which could be used with profit. 
Every pupil ought to know what his town, city, 
county, State, and the Nation are doing for the 
health of the people. An attempt should now 
be made to get children to develop certain stand- 
ards in connection with community hygiene. The 
inspection of model dairies, bakeries, markets, 
etc., would be admirable. But the duty of the 
citizen in maintaining and improving his own 
health, and that of others, the support of all 
public and community enterprises for the public 
health — all these are of fundamental impor- 
tance. Every child ought to be able to give the 
names of the health officers, tell how and when 
they are elected, and made to feel the impor- 
tance of getting desirable men into office. 

16. Free printed matter on hygiene 

So rapid, indeed, are the developments in the 
field of hygiene that the best-prepared teacher 
finds that many facts in even the advanced text- 
books become obsolete in a short time. The 
teacher who desires a broad background must de- 
pend on information beyond that found in the 
children's textbooks. Reference books for teachers 
are desirable, but not always available. Helpful 

75 



THE TEACHING OF HYGIENE 

libraries are often inaccessible. Fortunately there 
is rather a large amount of reliable printed mat- 
ter on health which can readily be gathered with 
little or no expense. The vast majority of teachers 
are probably unaware of the existence of this 
material, the ease with which it can be procured, 
and the uses to which it may be put. 

17. How secured — general sources of supply 

One source of supply within the reach of all 
teachers is the newspaper and popular magazine. 
While such material is not always authentic, 
much of it is valuable, and, if properly used, may 
be stimulating. If the school is to be efficient, it 
should, of course, consider particularly the health 
problems of the pupils' own environment. A gen- 
eral observation on the part of the teacher cou- 
pled with good sense is worth while; but informa- 
tion more accurate scientifically is frequently 
available. The report of the local board of health 
is often published and may be secured from the 
secretary of the board of health. Many of our 
state boards of health publish monthly bulletins, 
which not only give a general survey of the health 
conditions of their respective States, but often 
have popular scientific articles by health experts. 
Many of these boards — notably in Michigan, 

76 



SUGGESTIONS ON METHOD 

Kansas, Virginia, Florida, Ohio, Wisconsin, North 
Carolina, New York, Maine, and Illinois — pub- 
lish excellent bulletins and pamphlets on health. 
They give information of the greatest value 
about epidemics,, how prevented and controlled, 
and the most recent advances in medical science; 
also many practical hints on how to keep well. 

A postal card directed to the secretary of your 
state board of health will put you on the mailing 
list and you will receive publications as fast as 
they come out. Many of the state departments 
of agriculture also publish useful pamphlets, par- 
ticularly on foods, pure milk, farm water, sup- 
plies, and sewerage. Many valuable pamphlets 
,on hygiene may be secured from the following 
bureaus and departments of the United States 
Government, Washington, D.C.: Bureau of 
Education, Department of Agriculture, Public 
Health Service, and the Department of Labor. 
A certain number of these pamphlets when first 
issued are free. When this supply is exhausted, 
they may be purchased as long as they last at a 
nominal price from the Superintendent of Docu- 
ments, Washington, D.C. A catalogue of these 
publications will be sent on application. Several 
insurance companies publish pamphlets on hy- 
giene for their policy-holders which are very valu- 

77 



THE TEACHING OF HYGIENE 

able to teachers. The Metropolitan Life Insur- 
ance Company, New York, has probably the best 
set. The company is glad to furnish them to 
teachers on application. 

18. How used — some general suggestions 
Pamphlets and illustrative materials when col- 
lected by the teacher should be classified and 
manipulated so that they may be easily referred 
to. One of the best methods is to put materials 
into good-sized manilla envelopes labeling them 
"flies," "mosquitoes," "milk," etc. Every 
school should have a bulletin board l on which 
the children may be encouraged to tack clippings, 
etc. When the teacher is about to take up a given 
topic she will find it helpful to refer to her ma- 
terials, find illustrative material or possibly 
printed matter, and tack it on the board. In con- 
nection with the discussion of the house-fly, for 
example, there are many illustrations and terse 
sayings that children would find interesting. No 
matter what the character of the lesson the teacher 
may find something in her envelopes to enrich it. 

1 If the schoolroom is without a bulletin board, the resource- 
ful teacher may easily secure one that will answer the purpose 
temporarily. Ask the children to bring the largest pieces of 
cardboard they can find, and fasten them to the wall. Let 
them also provide tacks to fasten clippings. 

78 



SUGGESTIONS ON METHOD 

If a class is considering the danger of the con- 
tamination of the milk supply, it should be a sim- 
ple matter to refer to the State, or better, the 
county or town where the pupils live. 

A collection of materials referred to may also 
be useful in educating parents. If there are par- 
ent-teacher associations, the teacher may rind 
plenty of material for talks or the parents may 
be invited to use the material. Every library of 
pamphlets should contain some useful informa- 
tion on child welfare. So far as possible the 
teacher should let the people of the community 
know that she has such material and encourage 
them to make use of it. The teacher might find 
it profitable also to collect pamphlets on other 
topics, such as agriculture. 

The neighborhood of the school does not al- 
ways offer an opportunity to observe ideal health 
conditions. In such cases teachers may often use 
pictures effectively. Pictures may show pupils 
the difference between a model dairy farm and one 
which is a menace to the health of the community. 
Current magazines frequently have excellent 
pictures on health that might easily be preserved. 
The stereopticon is an excellent method of giving 
visual instruction. It can be used with profit, not 
only in teaching hygiene, but the other subjects of 

79 



THE TEACHING OF HYGIENE 

the curriculum as well. Besides being useful in 
giving instruction in the school, a stereopticon I 
could be used to advantage in parent-teacher j 
associations. Almost any enterprising teacher, ' 
either in a city or country school, could earn 
money for a stereopticon by giving school enter- 
tainments to which a slight admission might be 
charged. For use in the ordinary schoolroom, a 
stereopticon should be moderate in price, porta- 
ble, and easily adjusted. A number have appeared 
on the market. The writer has found the Balopti- 
cons, manufactured by the Bausch, Lomb Opti- 
cal Company, Rochester, New York, admirably 
adapted for school work. It is becoming easier 
each year to buy, rent, and borrow slides. Some 
manufacturing concerns, boards of health, agri- 
cultural colleges and normal schools will send 
their slides to schools free of all expense except 
the cost of transportation. The following firms 
are prepared to furnish lantern slides on health 
problems at reasonable prices: Educational Ex- 
hibition Company, 26 Custom House Street, 
Providence, Rhode Island; Keystone View Com- 
pany, Meadville, Pennsylvania; * Underwood & 
Underwood, 417 Fifth Avenue, New York City. 

1 This firm also has a number of stereoscopic pictures on 
health. 

80 



SUGGESTIONS ON METHOD 

ig. Planning a health day — making use of 
printed matter, exhibits, essays 

In some States a week or day has been set apart 
by the legislature or by a proclamation of the gov- 
ernor for the special consideration of health prob- 
lems. In Michigan, where this movement seems 
to be well under way, many towns make a special 
effort during this week to get lectures, exhibits, 
moving pictures, etc., to further the war against 
disease. This is a splendid opportunity for the 
teacher to profit by this community enthusiasm 
and ambition. It is easier to give instruction in 
the schools when the work of the school is cordially 
supported by the community, and it then be- 
comes also relatively easy to influence the com- 
munity. Whenever there is a general observance 
of a health day or week, the teacher should make 
a special effort to do something effective, some- 
thing that will involve the cooperation of all the 
pupils. It would be desirable to vary the plan 
somewhat each year. If there is no public ob- 
servance during a particular day or week, the 
school might have a health day of its own. If this 
is undertaken, the work should be planned and 
carried out so far as possible by the children with 
a minimum of suggestion from the teacher. An 
81 



THE TEACHING OF HYGIENE 

invitation should be extended to the parents and 
patrons of the school. If the teacher can really 
get the children interested, there will be no dif- 
ficulty in getting the parents to attend. What 
may be done? First of all there may be an exhibit 
of hygienic devices made by the children, such as 
fly-traps, fly- " swatters," paper drinking-cups, 
etc. Then the free publications, carefully classi- 
fied, may be arranged on the walls of the school- 
room with some explanatory cards made by the 
children. Some of the children might act as 
guides for visitors. If the guides are allowed to 
wear ribbons or badges, it will add to the interest. 
The school grounds should be well cleaned up. 
Exercises such as games, dances, gymnastics, etc., 
might also be on the program. Some of the older 
children might prepare essays on health which 
might be read or exhibited on the wall. The public 
occasion would be stimulating to pupils. In some 
cases it would be well to have one or two of the 
best essays published in the local newspaper. 
Essays might be prepared on such topics as 
these: — 

i. What the board of health is doing for the health 
of the community. 

2. The cause of some serious epidemics in our city. 

3. A model dairy which I visited. 

82 



SUGGESTIONS ON METHOD 

4. A model bakery which I visited. 

5. The heal thf ulness of our town compared with 
others in this State. 

6. How the citizens may help the cause of health 
at the polls. 

7. What a reputation for good health means to a 
city. 

8. What I saw at a tuberculosis exhibit. 

9. How the boys and girls of this school may do 
something for the public health. 

10. How to make a fly-trap. 

1 1 . How I formed the habit of correct posture. 

12. The dangers of a public drinking-cup. 

13. How the victory was won over malaria. 

14. How parents may help to make our schoolhouse 
and grounds more sanitary. 

15. The value of good teeth. 

The wide-awake teacher may think of other 
topics worth while, or, better still, they may be 
suggested by the pupils. 

As an illustration of what may be expected in 
essay writing in the grades, I submit an essay 
prepared by a child in the sixth grade on the 
general subject of how the sanitation of a town 
might be improved : — 

There is more than one way of improving sanita- 
tion in our town. Some of the ways are as follows: — 
We should have baskets or boxes on prominent 

83 



THE TEACHING OF HYGIENE 

corners of our streets and require citizens to throw 
papers and peelings and all rubbish into the bas- 
kets. 

As flies collect around uncovered food the gro- 
cery men must keep all supplies protected properly. 
Housekeepers ought to band together and agree to 
buy only of dealers who will carry out this rule. 

Streets and gutters must be cleaned very often. 
One way of having this done without much cost and 
teaching the children at the same time, would be to 
have a holiday from school and form the boys and 
girls into companies and let them do the work. The 
girls could sweep and gather rubbish and the boys 
could carry it away in baskets or 'haul it in wagons. 
In this way the children would take more pride in 
keeping their city clean. 

Some people think the alley is a good place to 
dump all rubbish, but it is just as important to keep 
the alleys clean as front yards, because any insani- 
tary condition is as dangerous one place as another. 
So rubbish should not be allowed to accumulate. It 
might be a good plan to appoint school boys as in- 
spectors of certain streets and give a prize to the one 
who can show the best condition on his beat. 

The law requiring all manure to be covered and 
carried away regularly should be enforced better than 
it is. Owners should be urged to treat it with borax 
at the rate of three fifths of a pound to eight bushels 
of manure. 

The back yards should be kept free from weeds 

84 






SUGGESTIONS ON METHOD 

and damp places. The method of disposing of house- 
hold garbage could be improved upon as follows: — 

All garbage should be drained of water and wrapped 
in paper and put in covered cans. At stated periods 
this should be taken outside the city limits. One of 
the ways of disposing of it is to sell or give it to farm- 
ers for their stock. If obliged to keep garbage on the 
premises in uncovered receptacles, it should be cov- 
ered with kerosene oil or dusted with borax. 

One sanitary improvement for the ward schools 
would be the supplying of Scott tissue towels; also 
regular inspection of the health of the children by 
doctors, nurses and dentists and talks by these peo- 
ple to pupils on the value of sanitation would be 
helpful. 

The boys in the manual training department might 
be allowed to make window screens and simple fly- 
traps and fly-swatters for home use. Screens should 
be supplied for schools. 1 

The ingenious teacher will find many other 
profitable ways of celebrating health day, and 
making use of printed matter. 

1 Taken from Public Health, published by the Michigan 
State Board of Health, Lansing, August, 19 15, vol. 111, no. 8, 
p. 40. 



IMPORTANT PROBLEMS AND THEIR 
SOLUTION 

Although much has been said about subject- 
matter and methods of teaching in the previous 
pages we shall now attempt to consider more 
systematically the most important problems in 
hygiene and how the teacher may meet them 
successfully. 

i. Alcohol and health 

The rapidly growing interest in health educa- 
tion assumed its initial force in 1879 when the 
Woman's Christian Temperance Union began its 
propaganda for temperance instruction in the 
public schools. The plan was to make physiology 
entirely subservient to this kind of instruction. 
One of its publications claimed that temperance 
instruction should occupy at least one fourth the 
space in the textbooks. So much interest was 
aroused in this movement that by 1900 nearly 
all the States had passed laws requiring instruc- 
tion in physiology, with special reference to the 
86 



IMPORTANT PROBLEMS 

nature of alcohol and its effect upon the human 
body, to be given in the public schools. These 
laws still remain upon the statute books; but, as 
Berry (9) says, " the consensus of opinion seems to 
be that this instruction in physiology and hygiene 
has not been a success." Small (50) suggests that 
"the increased per-capita consumption of both 
alcohol and tobacco in the generation during 
which ' scientific temperance instruction ' has had 
place in the schools is sufficient proof of the fail- 
ure of the specific aim of the movement." 

It is difficult to formulate a constructive pro- 
gram for the successful teaching of the effects of 
alcohol on the human body, so that desirable 
action may be insured, because (1) there has been 
so little teaching of this kind that has been com- 
mendable, and (2) it is practically impossible to 
give any kind of training in action. This kind of 
training is possible in oral hygiene. Instruction 
may be given about the necessity of cleaning the 
teeth, and the children may then be followed up 
quite satisfactorily until the habit has been cul- 
tivated. If the habit is once formed, the proba- 
bility is that it will be continued throughout life. 
We cannot be certain of a satisfactory outcome 
like this in teaching about the harmful effects of 
alcohol. We must present facts and then hope 

87 



THE TEACHING OF HYGIENE 

that the right kind of attitude and action will 
result. The efficiency of this teaching will hinge 
largely, then, on the knowledge which the chil- 
dren acquire and the way it is acquired. The 
writer would venture the following sugges- 
tions: — 

(i) The teacher should be careful not to ex- 
aggerate the evil effects of alcohol on health. 
Undue exaggeration in the past has been respon- 
sible in a measure for failures in teaching. The 
magnifying of these evils so that they become 
ludicrous defeats the very purpose of the in- 
struction itself. There is a vast amount of printed 
matter on the effects of alcohol on the human 
body, but most of it is worthless, either because 
it was prepared by those who were frankly prej- 
udiced at the beginning, or because the so-called 
scientific experiments that are exploited involved 
faulty methods of procedure. There are some 
truths, however, which seem to rest upon a sound 
scientific basis ; namely, that alcohol is a danger- 
ous drug; that it is not necessary for healthy liv- 
ing; that it weakens man's resistance to disease; 
tends to shorten the length of life, as is shown in 
the statistics of life insurance companies, and im- 
pairs the functions of brain and muscle. Teachers 
will find valuable the discussion of this subject in 
88 



IMPORTANT PROBLEMS 

Fisher and Fisk's How to Live (New York: Funk 
& Wagnalls, 191 5). 

(2) The teacher should emphasize the moral, 
economic, industrial, and social effects of drink- 
ing. The opinion is gaining ground that these 
are more serious for society than the result of 
drinking upon health. 

It has been proved now beyond a doubt that 
alcohol is a narcotic and that it influences first 
the higher centers of the nervous system, those 
parts that have to do with the higher intellectual 
and inhibitory processes. The freer tongue and 
unusual behavior of one who has recently taken 
alcohol are results, not of stimulation, but of a 
temporary paralysis of the nervous system hav- 
ing to do with control. The yielding to many a 
temptation, the execution of many a crime, have 
happened when the instincts, and not the higher 
impulses of man, have been operative. Rosenau 
(48) says: "The fact that alcohol lowers moral 
tone does much more harm than all the cirrhotic 
livers, hardened arteries, shrunken kidneys, in- 
flamed stomachs, and other lesions believed to be 
caused by its excessive use." 

Since alcohol deadens the thought, judgment, 
and will of the drinker, it cannot be thought of 
as anything but harmful to work, especially the 
89 



THE TEACHING OF HYGIENE 

highest type of work such as is done by the 
engineer and the business man. Some of our best 
business organizations to-day will dismiss from 
their employ men known to drink or even to 
frequent the saloon. 

Alcohol must also be held responsible for a 
large number of accidents. The reading of the 
daily newspaper, with its accounts of men run 
over by trains, automobiles, and teams, and the 
laconic statement of the cause as intoxication, is 
convincing. Industry has recently recognized 
this. At the annual meeting of the National 
Council of Safety, which was attended by rep- 
resentatives from several hundred large indus- 
tries, a vote was passed unanimously by the 
members to abolish liquor from their plants. 

The drink bill of tins country is enormous, 
totaling $610,000,000, and it is almost all waste. 
The brewers, who, of course, have serious finan- 
cial interests at stake, may tell about the num- 
ber of people employed in the manufacturing, 
distribution, and sale of alcohol and the bushels 
of the farmer's grain that are used, but this is 
no valid argument for its general use. The man- 
ufactured product, besides being responsible for 
one of our worst social evils, helping to fill our 
jails, poorhouses, and asylums, cannot be proved 
90 



IMPORTANT PROBLEMS 

to contribute one iota to the welfare of the Nation 
except as it is used as fuel or for other industrial 
purposes. Every nation now at war by its restric- 
tions on the manufacture and sale of intoxicating 
beverages has taught the world that the making 
of alcohol wastes grain needed for food and that 
its use undermines military efficiency. The wealth 
spent for liquor could be spent on education, bet- 
ter health supervision, good roads, and legitimate 
industry employing the same number of people 
and bestowing a blessing upon mankind. 

The driving home of these facts, backed up by 
many concrete truths such as are now available, 
would give the pupils of our public schools an 
intellectual grasp of the problem; if they can be 
driven home with conviction our instruction will 
function probably to a larger extent in conduct. 

(3) It is a platitude to say that instruction 
which does not call forth the interest of the pupils 
cannot be expected to be effective, yet that has 
been characteristic of nearly all the instruction 
relative to the use of alcohol. Since this sort of 
instruction must depend wholly on the imparting 
of knowledge, the problem is to impart the knowl- 
edge so vividly that definite and permanent atti- 
tudes may be aroused; otherwise the instruction 
must be a failure, for it is not knowledge so much 
91 



THE TEACHING OF HYGIENE 

as attitude that counts. Here is practically a 
virgin field pedagogically, and some careful ex- 
periments would be of value. Interest and con- 
viction must begin, of course, with the teacher. 
So long as this topic is taught because it has to 
be taught and is slighted whenever possible, we 
cannot expect results. One resource of unques- 
tioned value would be to try to connect the dis- 
cussions with the children's ambitions and ideals. 
Here is a boy, for example, who wishes to be a 
policeman. Let him try to find out whether the 
use of alcohol would help him to be a good police- 
man. The teacher or pupil may find some city 
regulation on this, or possibly a letter might be 
sent to the chief of police who would be pleased 
to give the information. Such studies might in- 
volve everybody in the class personally and be 
very much worth while. Another suggestion 
would be to get the children to bring in all the 
arguments they can collect, either from news- 
papers or magazines or from people who use 
liquor, as to why liquor is helpful to mankind. 
Some of these arguments might be: "It is a pro- 
tection against extreme cold, against disease," 
etc. After these arguments were all collected 
they might be assigned to different individuals, 
the problem being to find out whether they were 
92 



IMPORTANT PROBLEMS 

true. The textbook and other references might 
be consulted. Dealing with cold-blooded facts in 
a concrete world instead of preaching is much 
more likely to be worth while. 

The final question for discussion should prop- 
erly be: "What attitude should we as citizens 
take toward the drinking of alcohol?" No dis- 
cussion of this kind would be complete which did 
not lay emphasis on the danger of habit formation 
and the desirability of avoiding even the first glass. 

2. The use of tobacco 

The effect of the use of tobacco on health has 
long been regarded as one of the most important 
topics in physiology and hygiene, and, like the 
discussion of alcohol, is frequently brought in 
with the consideration of each topic in the text. 
The statements as to its evil effects have been so 
exaggerated that the instruction has doubtless 
defeated its own ends. Many of the investiga- 
tions that have been made have been so negligent 
in weighing all the factors involved that they are 
difficult to interpret and often quite misleading. 
Nevertheless, from the mass of evidence and 
opinion with which medical literature is loaded, 
it seems indisputable that tobacco in all its 
forms contains powerful narcotic poisons and 

93 



THE TEACHING OF HYGIENE 

that it has never been proved that it has exerted 
any beneficial influence on the human body in 
health. Statements made by lovers of the weed 
as to its value have never been proved. In some 
individual cases there is enough resistance to 
render moderate use of tobacco practically harm- 
less. In the case of the adult, it is unnecessary 
and it may be harmful. There seems to be little 
doubt that the use of tobacco by children is 
harmful. Few will object to the statement that 
the use of tobacco is expensive, in reality a waste, 
and that it is a filthy habit. All these facts should 
be pointed out to children, and, as in the teach- 
ing about intoxicating drinks, it should be im- 
pressed upon them that certain ambitions which 
they may have, such as becoming good athletes, 
cannot be realized if they use tobacco. The pos- 
sibility of giving training is very slight, but a 
sympathetic teacher who has got well acquainted 
with boys may sometimes get them to break their 
habits of using cigarettes. Teachers will find val- 
uable the discussion of the use of tobacco in 
Fisher and Fisk's How To Live, pp. 250-68. 

For a most judicial survey of all the evidence 
the reader should consult Dr. Burnham's "The 
Effect of Tobacco on Mental Efficiency, " Peda- 
gogical Seminary, September, 1917, pp. 297-317. 
94 



IMPORTANT PROBLEMS 

3. Prevention and care of colds 

Colds are usually thought of as minor maladies 
that are to be expected with the coming on of 
winter, just as much as one expects snowfall in 
January or the song-birds to come back in the 
spring. The truth is that colds greatly lessen our 
efficiency and diminish our bodily resistance, often 
laying the foundation for more serious troubles, 
and they are mostly preventable. Children need 
to be taught that colds are contagious and the 
ways in which they may be prevented. A prop- 
erly heated and ventilated schoolroom, exercise in 
the open air, cold baths, daily movements of the 
bowels, and plenty of sleep are all important in 
a campaign of prevention. Teachers who find 
out through their own surveys of the children's 
health, that certain children are subject to colds 
in winter would often be able to talk the mat- 
ter over with the children and suggest a change 
of habits. 

Children should also be taught what to do 
when the cold is contracted or when it is felt to 
be coming on. If the cold is taken in time, it 
may be cured often without much difficulty. The 
medical inspector, too, at the suggestion of the 
teacher, may often impress upon the child the 
95 



THE TEACHING OF HYGIENE 

need of certain hygienic habits to prevent or care 
for colds. 

Some of the best discussions of the prevention 
and care of colds are found in Hough and Sedg- 
wick's The Human Mechanism, pp. 380-95; 
Fisher and Fisk's How to Live, pp. 272-80; 
Woods Hutchinson's Preventable Diseases (Bos- 
ton: Houghton Mifflin Company), pp. 86-93; 
William S. Sadler's The Cause and Cure of Colds 
(Chicago: McClurg, 19 10, pp. 147). 

4. Fresh air and tuberculosis 

Tuberculosis is the most deadly scourge of the 
human race. It is estimated that about one hun- 
dred and sixty thousand people die each year in 
the United States from this disease.. It is espe- 
cially burdensome to society because so many of 
the deaths occur in middle life when individuals 
are best prepared to make their greatest contri- 
butions to human progress. We now know that 
tuberculosis is no longer a hopeless disease, but 
that it may be prevented and cured. Recogni- 
tion of these facts has led many States to pass 
laws requiring that children be given instruction 
concerning the nature, prevention, and cure of 
tuberculosis. Whether such instruction has been 

96 






IMPORTANT PROBLEMS 

made compulsory or not it should be given in 
every elementary school. 

It is decidedly unwise, however, to teach chil- 
dren in the lower grades the symptoms of the dis- 
ease or to quote statistics showing its frightful 
mortality. Such facts would be little understood 
and might arouse a morbid dread. It is doubtful 
whether it is even desirable to refer to the disease 
by name. In the lower grades the strategic attack 
upon tuberculosis, as upon every other disease, is 
to get those habits formed that make tuberculosis 
impossible. Habits like correct posture, taking 
exercise daily in the open air, daily movements 
of the bowels, sufficient sleep, avoiding direct 
contact with others, especially sick people, pre- 
vent tuberculosis. Teachers who know positively 
that particular children have tuberculosis, or 
have symptoms of it, may give such children 
special study, direct them as to their habits, get 
the cooperation of the home; and, if that is not 
adequate, they may often get the help of chari- 
table associations so that fresh air, rest, and nour- 
ishing food may be provided. (See pp. 64-65.) 

In the higher grades, the disease should be 
referred to by name and some idea given of its 
mortality. The losses from tuberculosis may 
often be compared with advantage to those 

97 



THE TEACHING OF HYGIENE 

sustained by the Nation in actual fighting during 
our Civil War. It is estimated that the mortal- 
ity from tuberculosis for four years far exceeds 
the number of deaths in battle during the four 
years of the Civil War. Children should also be 
taught the specific ways in which the disease is 
spread, such as through the sputum and direct 
contact, and the methods most successful in 
preventing and curing the disease. 

Nearly all our recent textbooks in hygiene 
have good chapters on tuberculosis. Splendid 
articles are frequently found in current maga- 
zines, and nearly all state boards of health have 
published bulletins that teachers may secure 
free. "Tuberculosis and the School/' a chapter 
in Terman's The Health of the School Child, is 
especially worthy of the teacher's attention. One 
of the best single volumes on the subject is by 
Edward 0. Otis, The Great White Plague (New 
York: T. Y. Crowell & Co., 1909, pp. 321). 

5. Cleanliness 

All habits of cleanliness are desirable in the 
interests of general decency, but some habits are 
rather inconsequential to health. General habits 
of cleanliness should be cultivated in the grades, 
but those having significance for health should 

98 



IMPORTANT PROBLEMS 

be insisted upon. Keeping desks neat and orderly, 
sometimes emphasized by many teachers, is im- 
portant in the cultivation of an ideal of neatness 
and cleanliness, but it has little direct bearing 
on health. Keeping the hands clean, however, 
is so important hygienically that it should be 
one of the minimum essentials in hygiene in 
every school. 1 If human beings would learn to 
keep the unwashed hand away from the mouth, 
many diseases would be diminished; for the hand 
so often coming in contact with infectious matter 
may easily be a source of illness, as it is by 
chance introduced into the mouth or as it touches 
food. The Health Department of the City of 
Boston says that the following rules should be 
adopted by everybody: — 

WASH THE HANDS IMMEDIATELY 

Before eating. 

Before handling, preparing, or serving food. 

After using the toilet. 

After attending the sick. 

After handling anything dirty. 

1 The lack of facilities for washing the hands in many 
schoolhouses shows how unimportant health is regarded by- 
most school teachers and school officials. One of the largest 
cities in the United States does not furnish even paper towels 
for its school children, and even if it did, in many school 

99 



THE TEACHING OF HYGIENE 

Not all these rules can be carried out in the 
schoolroom; but children may at least be taught 
the importance of these rules of health, and the 
teacher, by presenting right motives and by 
daily inspection of hands, may get the children to 
form the habit of keeping the hands clean while 
in school. The ingenious and interested teacher 
will find many devices and many opportunities 
from day to day to encourage these individual 
rules. The teacher will find helpful The Cost of 
Cleanness, by Ellen H. Richards (New York: 
Wiley, 1908, pp. 109). 

6. Exercise and play 

Nothing in hygiene is more certain than that 
vigorous muscular activity is necessary for 
healthy living. It enables one, through the edu- 
cation of the heat-regulating apparatus, to cope 
with the varying temperatures of daily life; it re- 
lieves internal congestion, strengthens the heart 
and lungs, promotes better digestion, and by the 
stimulation of the flow of the lymph directly 
affects the nutrition of the cells and the elimina- 
tion of their waste products. The transition to 
our modern life has been detrimental to the oppor- 

buildings there would be little chance to wash the hands be- 
cause of insufficient washbowls or other similar equipment. 

IQO 



IMPORTANT PROBLEMS 

tunity and desire to take exercise. The conges- 
tion of the population, the increase of sedentary 
occupations, and the almost universal use of 
trolley, train, and automobile have tended to 
make walking unpopular. Yet it is obvious that 
no amount of fresh air breathed on open cars or 
automobiles or the mental stimulation of a change 
of scene can recompense for the lack of exercise. 
It might be assumed that these observations 
would not apply to rural districts, but it must be 
remembered that the introduction of modern 
agricultural machinery has lessened the farmers 
exercise and has often led him to take unhealthy 
postures. This growing tendency to decrease 
the amount of physical exercise has had a per- 
nicious effect. It is now believed to be largely 
responsible for the rapid growth of degenerative 
diseases and the rapidly rising death-rate after 
the age of forty. Ehler (23a) estimates that sixty 
per cent of city and small-town children have no 
vigorous muscular activity. Their vital possi- 
bilities are never realized, so their present and 
future efficiency must suffer. 

Teachers, particularly in city schools, must do 
something to overcome the modern temptation 
to coddle ourselves so that the necessity for walk- 
ing or taking some other kind of exercise is looked 
101 



THE TEACHING OF HYGIENE 

upon as a misfortune. In systematic lessons the 
teacher may see that the children get accurate 
information on the need of exercise and the value 
of different kinds of exercise, but this alone would 
be largely a waste of time. In some way the school 
must make muscular activity popular. The chil- 
dren ought to get a permanent interest in taking 
exercise so that in later years they will feel de- 
cidedly uncomfortable if exercise is omitted. 
This ought not to be difficult, for one of the most 
fundamental instincts is that of muscular activ- 
ity. All the school needs to do is to provide an 
opportunity for its expression and direct it into 
proper channels. This instinct, as it manifests 
itself in the little child, is characterized by an 
interest in the exercise itself rather than in an end 
and is referred to as play. The play spirit in- 
volves a f orgetfulness of self and a buoyancy and 
enthusiasm invaluable for health and mental de- 
velopment. If play is properly directed it leads 
to a permanent interest in physical activity. 

Every teacher may do a good deal to encour- 
age play in the open air. If she knows how to 
play a large number of games she will find the 
children eager to learn. No teacher can afford to 
be without some little manual on games. John- 
son's What To Do At Recess (Ginn & Co.) is a help- 
102 



IMPORTANT PROBLEMS 

ful and inexpensive book. Plays and Games (Ginn 
& Co.), by the same author, is much more com- 
plete. Bancroft's Games for the Playground, Home, 
School and Gymnasium (The Macmillan Company, 
New York) and Stecher's Games and Dances 
(J. J. McVey, Philadelphia) are probably the 
most complete books available. All pupils should 
be encouraged to take part in the school play 
during the recess periods. There is also an op- 
portunity to take children on walks to study 
natural phenomena. This is exceedingly valu- 
able, not only because walking is a splendid 
type of exercise, but also because walking for a 
purpose helps to cultivate permanent interest in 
such physical activity. In New York State' a 
new program for physical education has been 
proposed which provides that pupils may get 
credit in hygiene for field trips. 

Although the recess periods may be utilized 
profitably without special play apparatus, an 
addition of a box of sand, slide, horizontal bars, 
swings, trapeze, and teeter-boards will make the 
playground much more attractive and will also 
provide some desirable forms of exercise not 
available in regular games. Many schools, par- 
ticularly rural schools, have earned enough money 
from school entertainments to purchase play de- 
103 



THE TEACHING OF HYGIENE 

vices. Sometimes "bees" of parents have hauled 
sand and constructed play contrivances. Some 
of the simpler forms of play apparatus might 
even be made by the children themselves as a part 
of their work in manual training. Suggestions for 
making such devices can be found in catalogues 
of manufacturers of play apparatus. Many of the 
fixtures for a playground may be purchased at a 
reasonable price. Discounts are usually allowed 
to schools. Attractive catalogues may be se- 
cured from the following reliable firms : Ashland 
Manufacturing Company, Ashland, Ohio; Hill- 
Standard Manufacturing Company, Anderson, 
Indiana; and American Playground Device 
Company, Anderson, Indiana. 

Every teacher should be familiar with the 
special kinds of exercise necessary to correct bad 
posture. A child who is flat-chested and round- 
shouldered needs individual attention. He should 
be carefully instructed as to the right kind of 
exercise. A certain amount of corrective training 
is possible in the school, but he should be required, 
as a part of his work in hygiene, to practice cer- 
tain exercises at home. A record should be kept 
for the inspection of the teacher and improve- 
ment noted. The problem of posture and its cor- 
rection is well presented in Bancroft's The Pos- 
104 



IMPORTANT PROBLEMS 

lure of School Children (The Macmillan Company, 
19 1 5, pp. 327). Some excellent home exercises 
are illustrated in Cromie's Keeping Physically 
Fit (The Macmillan Company, 1916, pp. 146). 

In addition to the references already given 
teachers will find a spendid discussion of the 
physiology and hygiene of play in Hough and 
Sedgwick's The Human Mechanism (Ginn & Co.), 
pp. 304-34. Teachers will find a treat in Joseph 
Lee's Play in Education (The Macmillan Com- 
pany, 1 91 5, pp. 494). Moses' Rhythmic Action 
Plays and Dances (Milton Bradley Company, 
191 5), and Van Cleve's Folk-Dances for Young 
People (Milton Bradley Company, 19 16), are 
unusually well illustrated and adapted for school 
work. Teachers in the rural schools will find ex- 
cellent suggestions in Curtis's Play and Recrea- 
tion (Ginn & Co., 1914, pp. 259). 

7. Care of the teeth 

The teaching of oral hygiene in the grades is 
usually limited to giving children information 
about the anatomy and physiology of the teeth, 
with a few suggestions as to their care. The tend- 
ency now in our best schools is to emphasize in- 
struction relating to the care of the teeth, but 
more particularly to train pupils in cleaning their 

105 



THE TEACHING OF HYGIENE 

own teeth. The information given should involve 
details as to care, followed by demonstrations of 
actually brushing the teeth, and later careful 
inspection by the teacher so that the habit of 
cleaning the teeth may be formed. Samples of 
toothpaste will often be supplied to teachers 
for demonstration purposes by manufacturers. 
Toothbrushes, if bought in quantities, may be 
purchased for a nominal sum. If cases arise when 
poverty or parental indifference make it impos- 
sible for children to buy a toothbrush, they may 
be encouraged to rub their teeth with a clean 
piece of cloth soaked in a salt-and-water solution, 
to rinse out the mouth with water after eating, 
and to use thread to remove remnants of food. 

All teachers need to emphasize the correct 
method of brushing the teeth, otherwise much 
harm may be done. The first essential is to have 
a good toothbrush with bristles that do not eas- 
ily break or pull out. Then the teeth should be 
brushed not only up and down and across, but also 
by a rotary or circular motion from the gums of 
one jaw over the teeth to the gums of the other, 
and so round and round. Dental floss should be 
used every day or so to remove the particles of 
food that often lodge between the teeth and 
cause decay. Most dentists also recommend a 
1 06 



IMPORTANT PROBLEMS 

good mouth-wash. The mouth may be rinsed 
beneficially once a day with lime water. Such a 
mouth-wash may be prepared by putting one 
half cup of finely powdered unslaked lime in a 
quart of water. At the end of twenty-four hours 
the clear liquid may be poured off and used to 
rinse out the mouth. The undissolved powder 
may be used for successive solutions until entirely 
dissolved. 

8. Foods and the hygiene of feeding 

To be properly nourished is essential to health 
and the ability to do one's best work. This 
problem is partly economic and partly hygienic. 
The solution of the hygienic problem depends, 
first, on selecting in the right proportions good 
foods; second, on the proper cooking of foods; 
and third, on normal processes of digestion and 
assimilation. Our courses in hygiene have had 
a tendency to lay too much emphasis on the 
physiology of digestion, to the neglect of the 
formulation of hygienic principles and the es- 
tablishment of habits. The work on foods has 
ordinarily been confined to learning and repro- 
ducing certain facts about foods, frequently in the 
exact words of the book. Such work is often too 
theoretical to be of much practical value. It is 
107 



THE TEACHING OF HYGIENE 

doubtful whether committing to memory the 
relative values of proteids, carbohydrates, fats, 
inorganic salts, and water, and the learning of the 
foods in which they are found will appreciably 
affect the lives of the pupils unless they are given 
some training, such as making out menus for 
different meals and possibly preparing the meals 
themselves. 

Practical work of this nature in our elementary 
schools has usually been offered in the course in 
domestic science. To insure the best kind of work, 
the instruction in both hygiene and domestic sci- 
ence courses should be planned so that each will 
supplement and reinforce the other. If domestic 
science is not taught, then hygiene might well 
attempt to stimulate some of those activities 
usually associated with domestic science. Often 
cooking may be done with a very modest equip- 
ment. If it cannot be done at school some experi- 
ments may be made at home. Some of our best 
teachers have found that if a warm lunch is pre- 
pared at noon, as it sometimes is in the rural dis- 
tricts, the lunch may be planned on different days 
by a committee appointed by the class and that 
habits of proper mastication of the food, washing 
the hands before meals, etc., may thus be culti- 
vated. In the kindergartens, where a lunch is 
108 



IMPORTANT PROBLEMS 

regularly served in the middle of the forenoon, 
there is a splendid chance to give the children 
training in simple but important hygienic habits 
and table manners. 

An excellent book on domestic science for the 
grades is Morris's Household Science and Arts, 
(American Book Company, pp. 249.) 

The United States Department of Agriculture 
will furnish free of charge a large number of ex- 
cellent bulletins on foods. The following partial 
list will be helpful: — 

M. H. Abel, Care of Food in the Home. (No. 357, 1915, 
pp. 46.) 
M. H. Abel, Sugar and Its Value as Food. (No. 535, 

1013, PP- 32.) 

H. W. Atwater, Bread and Bread-Making. (No. 389, 
1915, pp. 47-) 

H. W. Atwater, Poultry as a Food. (No. 182, 1915, 

PP. 39) 

W. O. Atwater, Principles of Nutrition and Nutritive 
Value of Food. (No. 142, 1910, pp. 48.) 

A. Barrows, The Farm Kitchen as a Workshop. (No. 
607, 1914, pp. 20.) 

A. Boss, Meat on the Farm; Butchering, Curing and 
Keeping. (No. 183, 1915, pp. 37.) 

J. F. Breazeale, Canning Vegetables in the Home. (No. 
359, 1915, pp. 16.) 

J. F. Breazeale and O. H. Benson, Canning Tomatoes 
at Home and in Club Work. (No. 521, pp. 36.) 

109 



THE TEACHING OF HYGIENE 

H. P. Gould and W. F. Fletcher, Canning Peaches on 
the Farm. (No. 426, 1910, pp. 30.) 

C. P. Hartley, J. G. Eillier, Pop Corn for the Home. 
(No. 553, 1915, pp. 13.) 

M. E. Jaffa, Nuts and Their Uses as Food. (No. 332, 
1910, pp. 28.) 

J. R. Keithley, Farm Butter-making. (No. 541, 1915, 
pp. 28.) 

C. F. Langworthy, Fish as Food. (No. 85, 1915, pp. 32.) 

C. F. Langworthy, Use of Fruit as Food. (No. 293, 

IQI5, PP- 38.) 

C. F. Langworthy, Potatoes and Other Root Crops as 
Food. (No. 295, 1915, pp. 45.) 

C. F. Langworthy and C. L. Hunt, Corn Meal as a 
Food and Ways of Using It. (No. 565, 191 5, pp. 24.) 

C. F. Langworthy and C. L. Hunt, Cheese and Its Eco- 
nomical Uses in the Diet. (No. 487, 191 2, pp. 40.) 

C. F. Langworthy and C. L. Hunt, Mutton and Its 
Value in the Diet. (No. 526, 1915, pp. 32.) 

C. F. Langworthy and C. L. Hunt, Use of Corn, Kaffir, 
and Cowpeas in the Home. (No. 559, 1913, pp. 12.) 

C. F. Langworthy and C. L. Hunt, Economical Use of 
Meat in the Home. (No. 391, 19 10, pp. 30.) 

Maria Parloa, Canned Fruit, Preserves, and Jellies. 
(No. 203, pp. 31.) 

Maria Parloa, Preparation of Vegetables for the Table. 
(No. 256, 1906, pp. 48.) 

L. A. Rogers, Bacteria in Milk. (No. 490, 191 2, pp. 23.) 

E. T. Wilson, Modern Conveniences for the Farm House. 
(No. 270, 191 5, pp. 48.) 

CD. Woods, Food Value of Corn and Corn Products. 
(No. 293, 1907, pp. 40.) 



no 



IMPORTANT PROBLEMS 

g. Pure milk 

In the study of foods milk needs to be espe- 
cially considered because it is one of the cheapest 
and best foods and also because it is more liable 
to carry infection than perhaps any other food. 
All these facts should be thoroughly understood 
by all pupils and also the way in which pure milk 
may be produced and cared for by the home. In 
the rural districts where the milk is produced, 
information about the necessity for clean milk 
and how it may be had is of greatest importance. 
If the teacher has at hand a copy of the reports 
of the local or state board of health she may get 
information about some local epidemic which 
would illustrate the necessity of the greatest care 
in the milk supply. City children also need to 
know about these things so that any kind of milk 
may not be thought of necessarily as "good milk." 
Taking a class to visit a model dairy would be in- 
teresting and profitable. If tins is impossible the 
good and bad conditions may often be presented 
through pictures which the teacher or children 
may find in books or magazines. 

The following free literature is recommended 
to teachers : — 

J. T. Bowen, S. L. Lambert, Ice Houses and the Use of 
in 



THE TEACHING OF HYGIENE 

Ice on the Dairy Farm. (U.S. Department of Agriculture, 
Farmers' Bulletin 623, 191 5, pp. 24.) 

R. D. Milner, The Use cf Milk as Food. (U.S. Depart- 
ment of Agriculture, Farmers' Bulletin 363, Washington, 
D.C., 1915, pp. 44.) 

Milton J. Rosenau, All about Milk. (Metropolitan Life 
Insurance Company, New York, 1914, pp. 33.) Invalua- 
ble to teachers, authoritative, comprehensive, illustrated, 
simple in language, interesting. 

G. M. Whitaker, L. A. Rogers, C. L. Hunt, The Care of 
Milk and Its Use in the Home. (U.S. Dept. of Agriculture, 
Farmers' Bulletin 413, Washington, D.C., 191 2, pp. 20.) 

Production of Clean Milk. (U.S. Department of Agri- 
culture, Farmers' Bulletin 602, 1914, pp. 18.) Illustrated. 
Would be valuable for teacher and pupils. 

10. Elimination of intestinal wastes 

Mental and physical vigor are impossible unless 
intestinal wastes are eliminated daily. Chronic 
constipation is a dangerous obstacle to health. 
The poisons which collect in the intestines, in- 
stead of being disposed of, are absorbed in large 
measure by the system, producing headache, 
general depression, dizziness, dullness, lack of 
energy, and chronic fatigue. It also , tends to 
lower the resistance of the body leading to colds 
and other serious troubles. Constipation is now 
believed to be largely responsible for piles, peri- 
tonitis, and appendicitis. Considering the im- 
portance of a daily movement of the bowels, the 
112 



IMPORTANT PROBLEMS 

work in hygiene in the grades would be decidedly 
defective which did not point out the dangers of 
constipation, how to overcome it, and even in 
some measure attempt to establish desirable hab- 
its. Relief is possible by overcoming the causes 
which are principally a run-down condition of the 
entire body, insufficient exercise, improper pos- 
ture, concentrated diet, improper clothing, insuf- 
ficient water, and irregular habits in evacuating 
the bowels. Many teachers will consider it rather 
indelicate to discuss this topic in class; but it 
may be taken up naturally in connection with 
foods and digestion, and is not embarrassing if the 
teacher will dispossess herself of the idea that it 
is unseemly. If health records are kept, similar 
to those referred to on pp. 56-57, there should 
always be a place to record the number of de- 
fecations per day. By looking over these records 
the teacher will discover abnormal conditions 
which, with the help of the medical inspector and 
sometimes with the cooperation of the parents, 
may be remedied. Teachers will find an excellent 
treatment of this topic in Fisher and Fisk's How 
to Live (New York: Funk & Wagnalls Company, 
191 5), pp. 51-56; Walters' Principles of Health 
Control (New York: D. C. Heath & Co., 1916), 
pp. 171-87. 

ii3 



THE TEACHING OF HYGIENE 

ii. The care of the eyes 

Our modern life puts a very serious strain upon 
the eye. If the eye is abnormal in its develop- 
ment, far-sighted, near-sighted, or astigmatic, 
the strain is greatly increased, causing extreme 
nervousness, headaches, dyspepsia, and other 
conditions of ill-health, interfering with one's 
usefulness and happiness. It is the business of 
the teacher to find out whether her pupils have 
normal vision. The Snellen Test Sheet, which, 
if it is not furnished by the school authorities, 
may be ordered from F. A. Hardy Company, 
New York and Chicago, will be of assistance. 
Such testing, however, sometimes fails to indi- 
cate those who are suffering from the most 
severe strain because pupils may sometimes read 
the letters on the card correctly and yet be 
doing it with difficulty. Pupils who are back- 
ward in their work, nervous, who suffer from 
inflamed eyes and complain of headache, may 
be looked upon with suspicion as having eye- 
strain. The survey of the pupils' health (see 
pp. 59-60) will help to discover these cases. 
Abnormalities of vision should be referred to 
the oculist and the support of the parents should 
be solicited. If glasses or treatment cannot 
114 






IMPORTANT PROBLEMS 

be secured, the teacher may often do some- 
thing to relieve the strain by moving children's 
seats so that board work may be seen better or 
by assigning work which will not involve strain. 
All children need to form good habits in using 
the eyes. Little children may get started in these 
habits by dramatizing. A committee from a class 
may try to reproduce a family sitting around a 
lamp — the mother sewing and the others read- 
ing. The position of different ones about the table 
is then criticized. Those who criticize may them- 
selves demonstrate a better position. On succeed- 
ing days the teacher may ask the children ques- 
tions to check up their home activities; such as 
"How many children when reading last night 
had the light coming from the rear? " The forma- 
tion of such habits is, of course, the most impor- 
tant phase of the instruction, but in the upper 
grades some anatomy and physiology should be 
taught, which would make clear the various de- 
fects and how they may be relieved. 

12. The care of babies 

There are at least two reasons why something 
on the care of babies should be taught in our 
elementary schools: (i) many of the older chil- 
dren take a good deal of care of their younger 

ii5 



THE TEACHING OF HYGIENE 

brothers and sisters, often doing the work of 
nursemaids outside of school; (2) caring for 
babies will be a responsibility for most girls 
later in life. The care of babies links itself easily 
to the other work in hygiene. The value of fresh 
air, elimination of bodily wastes, sleep, regular- 
ity of habits, pure milk, cleanliness, etc., may be 
shown to be as important if not more so than in 
the case of older children or adults. The whole 
subject needs, however, a more formal treatment 
in the seventh or eighth grade. 

The following literature which may be secured 
free will be of value to teachers : — 

Mrs. Max West, Infant Care. (United States 
Department of Labor, Bureau Publication, no. 8, 
1914, pp. 32.) 

The Child. (Metropolitan Life Insurance Com- 
pany, New York, 191 2, pp. 32.) 

These books are especially worth while: — 

L. E. Holt, The Care and Feeding of Children. 
(New York: D. Appleton & Co.) 

Dennett, The Healthy Baby. (New York: The 
Macmillan Company.) 

13. Sex hygiene 

The demand for the education of children in 
matters pertaining to sex has become widespread 
116 






IMPORTANT PROBLEMS 

within the last ten years. Many experiments have 
been made in our public schools with varying 
degrees of success and the whole movement has 
been subjected to bitter criticism. The writer 
believes that these experiments have not yet 
been extensive enough so that at present any 
positive statements can be made as to the pos- 
sibility of effective sex education in the school. 
The need of instruction in these matters seems 
imperative. Children at a very early age have an 
insatiable desire to know where they came from 
and other facts about life which have been evaded 
or untruthfully answered by parents. The mystery 
thrown around sex tends to intensify the child's 
curiosity, and, particularly in the case of boys, 
the desired information is gladly furnished by 
older boys or adults whose presentation of the 
matter is obscene and foul. Children are bound 
to get information if they cannot get it from the 
home or school, and in most cases it will be unre- 
liable and impure. The writer believes that at 
present and perhaps for all time instruction in 
these matters in the public school is unwise. The 
ordinary teacher, who lacks scientific training 
and has little or no sympathy with the matter, is 
not at all fitted to teach the subject with success, 
and the probability is that she may do more 
117 



THE TEACHING OF HYGIENE 

harm than good. The proper place for this in- 
struction is in the home. Those, however, who 
believe that the school is qualified to give this 
instruction say that the home will not accept the 
responsibility and that parents are not well 
qualified as teachers. This is probably true; but 
the teachers may help by informing themselves 
on the subject, lending their influence to agencies 
for the distribution of good literature on the sub- 
ject to parents, and also by encouraging meet- 
ings of parents where such matters may be talked 
over. Teachers should remember that one of the 
best prophylactics against sexual perversions is a 
permanent interest in things that are clean and 
wholesome. 

The American Social Hygiene Association, 
105 West Fortieth Street, New York, has many 
free publications and others at a nominal price 
that might be useful for teachers and parents. 
Richards's Hygiene for Girls (D. C. Heath & Co.) 
has a sensible division on the reproductive organs 
which girls in the upper grades might read with 
profit. Moore's Keeping in Condition (The Mac- 
millan Company) has some excellent material 
for boys on the control of the sex impulse. 

The following books are especially recom- 
mended for teachers and parents: Maurice A. 
118 



IMPORTANT PROBLEMS 

Bigelow, Sex Education (The Macmillan Com- 
pany); B. C. and V. M. Cady, The Way Life 
Begins (American Social Hygiene Association); 
T. W. Galloway, The Biology of Sex (D. C. 
Heath & Co.) 

14. The house fly 

"As harmless as a fly" was once a figure of 
speech in common use, but now, in the light of 
science, it would be better to say, "as dangerous 
as a rattlesnake"; for it has now been proven 
that the house-fly is hatched in filth, feeds on 
filth, and by the contamination of food carries 
disease and death. Dr. Howard has suggested 
that we ought to say "typhoid fly," and the re- 
naming of the fly in this way would doubtless 
contribute much toward its destruction. Pupils 
in the elementary school should have detailed 
knowledge about the life of the fly, his menace to 
health, and how he can be destroyed, and in 
addition every child should get some sort of 
training in actually destroying flies. That an 
entire city can practically be made flyless is shown 
by the results of the campaign of extermination 
in Cleveland which made it a "flyless city." 

Some simple information about the danger of 
the fly and encouragement in destroying him 
119 



THE TEACHING OF HYGIENE 

should come in the lower grades, but more de- 
tailed instruction should be planned for a later 
period, in perhaps about the seventh grade. The 
lessons to be vital should furnish some concrete 
experience. Dr. Hodge (37) suggests that volun- 
teers be called for to go into barnyards to get 
specimens of eggs, maggots, and puparia, and with 
them the filth in which they are found, so that 
the whole life history of the fly may be demon- 
strated. This method may seem rather repulsive 
to teachers, but it is sure to arouse interest and 
disgust for the fly as they see the maggots hatched 
from filth like horse manure. Dr. Hodge says 
that this experiment can be tried in a safe and 
clean way by "putting the material into large 
fruit jars or wide-mouthed bottles. If it is desired 
to keep them for several days to show actual de- 
velopment, they may require opening to give 
air once or twice daily, but they must be stop- 
pered or closed tightly, as maggots are strong and 
can burrow or squeeze through minute cracks." 
In connection with some of these experiments it 
may easily be shown how the breeding may be 
prevented by using a solution of iron sulphate 
or some other substance recommended to kill 
maggots in stables or outhouses. 

The teacher who is successful in arousing a dis- 
120 



IMPORTANT PROBLEMS 

gust for the fly will find it comparatively easy to 
get children to do something to eliminate it. 
When this is done the child gets an attitude to- 
ward the fly which is likely to persist perma- 
nently. Training in action may often begin on the 
school premises themselves, especially in the rural 
schools where the conditions are often favorable 
for the life of flies. A questionnaire sent to the 
rural schools of Worcester County by the State 
Normal School at Worcester shows that flies 
frequently infest schoolrooms and that few of 
the schoolhouses have their doors and windows 
screened. One rural teacher reported that she 
found it almost impossible to eat her lunch be- 
cause the flies buzzed around like a swarm of 
bees. The responsibility for the improvement 
of such conditions may well be shared with the 
pupils and their cooperation enlisted. Here is a 
chance to give an object lesson to the community! 
An investigation may be suggested to find out 
whether the flies are breeding on the premises. 
A breeding-place may sometimes be found in the 
outhouse. Such a discovery leads to a considera- 
tion of what can be done, the remedy, of course, 
being the application of some chemical solution 
like iron sulphate and the taking of simple meas- 
ures so that the privy vault is not exposed to 
121 






THE TEACHING OF HYGIENE 



flies. If the outhouse is not a breeding-place, 
or if they still continue to breed after adequate 
precautions have been taken, it is probable that 
the breeding-place is not on the school premises 
and so the school problem cannot be solved by 
destroying the breeding-place. The next thing 
is to get the doors and windows screened and to 
kill the flies. In cases where the school authori- 
ties would not provide screens, some enterprising 
teachers, with the help of the pupils and what they 
could bring from home, have been able to make 
screens. Whether such ambition and ingenuity 
are forthcoming or not the children may do 
something to kill the flies. Swatters and traps 
may be made by the children, and to arouse in- 
terest the school may choose sides to find out 
which side can kill and trap the most flies. To 
avoid infection the flies should not be counted, 
but measured. By sending four cents in stamps 
to the Agricultural Extension Department of the 
International Harvester Company, Chicago, ask- 
ing for Rome-Made Fly Trap — Directions for 
Making, the teacher may secure a folder with 
nineteen illustrations showing just how a fly 
trap may be made. By following this it will be 
easy to get older children to make them as a 
part of their manual training. 
122 



IMPORTANT PROBLEMS 

The Outlook (September 15, 1915, p. 137) 
publishes a picture of an ingenious trap which 
can be made easily out of a barrel. It might be 
effective near stables. The description follows : — 

To make one like this get a barrel and knock out 
both top and bottom. Then take a piece of wire net- 
ting and shape it into a cone eighteen inches high, 
the diameter of its base to be the same as the bottom 
of the barrel, leaving a one-inch space at its apex; 
fasten this securely to the bottom edge of the barrel. 
Over the top of the barrel put a flat piece of netting, 
so fastened that it can be easily removed when the 
flies are to be taken out. Next raise the barrel two 
inches from the ground by means of legs fastened to 
it. Now put some bait of non-sticky ingredients in a 
pie-pan and slip underneath the barrel. The flies 
come, eat their fill, and attracted by the light over- 
head, fly up into the cone and work their way through 
the small opening into the barrel. To kill the flies, 
turn the barrel on its head and pour scalding water 
over them. 

A trap on the same plan might be made out of 
a keg by a school for demonstration purposes. 

There is now a vast amount of literature on 
flies, much of it free, published by state boards 
of health and various departments of the Na- 
tional Government. The following books and 
pamphlets are to be recommended : — 
123 



THE TEACHING OF HYGIENE 

Hewitt, House-Flies and How They Spread 
Disease. (New York: G. P. Putnam's Sons, 
$40.) 

Howard, The House-Fly. (Stokes Company, 
$1.00.) 

Howard, House-Flies. (United States De- 
partment of Agriculture, Farmers' Bulletin 
no. 459> 1915, PP. 16.) 

R. H. Hutchinson, A Maggot Trap in Practi- 
cal Use — An Experiment in House-Fly Control. 
(United States Department of Agriculture, Bulle- 
tin no. 200, 1915, pp. 15.) 

Ross, The Reduction of Domestic Flies. (Phila- 
delphia: J. B. Lippincott Company, $1.50.) 

The Fly-Fighter , the official organ of the fly- 
fighting committee of the American Civic Asso- 
ciation, published in Washington, D.C., con- 
tains much information of interest to teachers 
and will be sent free upon request. 

15. The mosquito 

The mosquito, like the fly, has now been proved 
to be a menace to health. It is probably the sole 
carrier of malaria and of yellow fever. Although 
simple lessons on the mosquito should be given 
in the lower grades, the subject should be taken 
up more in detail in the upper grades. The method 
124 



IMPORTANT PROBLEMS 

of instruction should be similar to that given on 
the fly. The lessons may be made concrete and 
interesting to children by asking some of the 
children to bring in some water containing "wig- 
glers" and a few fruit jars. Fill each jar half or 
two thirds full of water and tie a piece of cheese- 
cloth securely around the top of each. The stages 
of larva, pupa, and imago may then be easily 
observed. Such simple experiments impart new 
interest and meaning to any reading done by 
the children. By pouring a little oil over the top 
of the water in one of the cans which contain 
larvae, or pupae, the children may readily see for 
themselves one way whereby the development 
of mosquitoes may be prevented. Every child 
should have accurate knowledge about the places 
where the mosquitoes breed, how they transfer 
disease and how they may be destroyed. The 
discovery that the mosquito is a menace to health 
is one of the brightest pages in the history of pre- 
ventive medicine, and the teacher will find that 
the children will absorb information much more 
readily if some of these stories are told. It is im- 
portant that children learn that all mosquitoes 
may not be dangerous because they are not the 
kind of mosquitoes that carry disease or simply 
because they have never been infected. Prudence 
125 



THE TEACHING OF HYGIENE 

would suggest, however, that we take necessary 
precautions against being bitten by them. 

Children may be profitably employed, as a 
part of the school work, in destroying any breed- 
ing-places found on the school premises or at 
their own homes. The story of what each one did 
might be a good theme for a composition. 

Many of the boards of health now issue valu- 
able pamphlets on the mosquito which the teacher 
should secure and place on file. The United States 
Public Health Service has prepared a pamphlet 
on the mosquito especially for teachers. It is 
entitled Carter's Malaria Lessons on Its Cause 
and Prevention. (Supplement no. 18 to the Public 
Health Reports.) An excellent book for the teach- 
er's reference is E. G. Mitchell's Mosquito Life. 
(New York: G. P. Putnam's Sons, 1907, pp. 271.) 

16. The destruction of rats and mice 

The fact that disease is spread by living organ- 
isms rather than inanimate things has led the 
investigators of the public health to look with 
suspicion upon all forms of animal life. This sus- 
picion is well warranted in the case of both rats 
and mice. Their destruction is desirable from a 
purely economic standpoint; for according to 
Surgeon R. H. Creel, of the United States Public 
126 



IMPORTANT PROBLEMS 

Health Service, it costs $1.82 to keep a rat for a 
year. The State Board of Health of Virginia in 
1 9 14 issued a bulletin entitled Rats — Kill Them, 
in which the astounding statement is made that 
rats cost the State half as much as it costs to run 
the Government. So far as the writer knows, no 
estimates are available for the mouse, but in 
proportion to his size he must be equally destruc- 
tive. Some idea of the destruction of which these 
small animals are capable may be had by read- 
ing Piper's The Nevada Mouse Plague of IQ07- 
08. (United States Department of Agriculture, 
Farmers' Bulletin no. 352.) But it is not only 
because the rat destroys man's wealth and is a 
parasite upon society that the school should lend 
itself vigorously toward his destruction; he is 
also loathsome in his habits and carries disease, 
notably the bubonic plague. 

Forbush, in his splendid study Rats and Rat 
Riddance, issued by the State Board of Agricul- 
ture of Massachusetts, introduces this subject 
with these striking words : — 

With the lapse of ages the rat has become a para- 
site on man. It has developed into the greatest rodent 
pest ever known. It is far more destructive, directly 
or indirectly, to human life and property than any 
wild beast or venomous serpent. It appropriates 
127 



THE TEACHING OF HYGIENE 

nearly everything that man eats, and drinks many 
of his beverages. It follows him with its baleful in- 
fluence from the cradle to the grave. It destroys 
his poultry and molests his domesticated animals. 
It has been known to attack and mutilate infants, 
sleepers, the sick, aged and infirm. It is the forerun- 
ner of famine, pestilence and death. It carries the 
germs of disease. It infects man's ships and habita- 
tions with the dreaded plague; sets fire to his dwell- 
ings and ships, and ceases its ravages only when the 
house burns or the ship sinks. As if not satisfied with 
pursuing him through life, it follows him in death, 
desecrating and mutilating his mortal remains. 

The need of the destruction of the rat is grad- 
ually being felt throughout the country as the 
public becomes better informed. Several States 
have already placed a bounty on the rat. In 
many places a systematic warfare is being waged 
through rat clubs. Women's clubs and other 
civic organizations are also beginning to lend a 
hand. The Women's Municipal League of Bos- 
ton has just issued a poster which tells in star- 
tling and terse language the danger of the rat 
and how he may best be destroyed. (See pp. 130- 

No course in hygiene in our elementary schools 
should fail to grapple with the rat problem. 
First, the children need to be informed that he 
128 






IMPORTANT PROBLEMS 

is a menace to the health and property of indi- 
viduals. To-day we have a decided antipathy 
toward the snake; but most snakes now found 
are harmless to man, and indeed it is possible 
to say that they are really helpful, for they de- 
stroy rats and mice. We need to cultivate the 
same sort of feeling toward rats and mice that 
we have now toward the snake, and also to spare 
the lives of snakes known to be harmless and 
other enemies of rats and mice. Secondly, chil- 
dren should be carefully instructed as to how 
the rat may be destroyed. Lastly, in order to 
make this knowledge effective and arouse the 
right feeling toward rats and mice, the pupils 
ought to be inspired to act. This is a problem 
which will appeal especially to the boys, but 
girls may also take part. In many homes the 
rats and mice may be pests and parents would 
gladly welcome any effort to have them elimi- 
nated. Get up a contest to see who can kill the 
most. Suggest as a future topic in English com- 
position, "How I trapped the Rats and Mice 
at Our House." 

While the more detailed consideration of this 

whole topic could probably be taken up best in 

the seventh and eighth grades, suggestions as to 

the destructiveness of rats and mice and encour- 

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THE TEACHING OF HYGIENE 

agement to kill them should be given incident- 
ally in the lower grades. 

In addition to the pamphlets referred to, the 
teacher will find the following helpful: David 
E. Lantz, How to Destroy Rats. (United States 
Department of Agriculture, Farmers' Bulletin 
no. 369.) The Rat and Its Relation to the Public 
Health. (Public Health and Marine Hospital 
Service, 1910.) This book may be secured by 
writing to the Superintendent of Public Docu- 
ments, Washington, D.C. 

17. The cat and sanitation 

It is doubtful whether in the interest of health 
and economic prosperity the continued existence 
of the cat can be logically defended. Almost at 
the dawn of human history the cat was the com- 
panion of man and has shared his fortunes from 
that day to this, even to having his diseases and 
infecting mankind. Dr. Caroline Osborne (43), in 
an extensive study of the cat in relation to disease, 
shows that the cat is susceptible to all species of 
disease germs which plague mankind. In many 
cases there is positive proof that the cat has 
transmitted disease to man, and the circum- 
stantial evidence is overwhelming in pointing 
out the cat as one of the most dangerous carriers 
132 



IMPORTANT PROBLEMS 

of disease to man. That she has the disease is 
enough to make us look upon her with suspicion. 
Knowledge of her habits and her close associa- 
tion with human beings forges the additional 
links in the chain necessary for her conviction. 
She is a universal scavenger, bringing in dead 
and decomposed birds and mice as well as those 
freshly caught. Cats left to themselves will visit 
the most obnoxious receptacles, thereby contract- 
ing some of the most serious feline diseases. She 
loves to roll in the dirt and in the disposal of 
her excreta digs in the dirt, getting dirt into 
her claws and so making it possible to inoculate 
with various diseases by her scratch. When we 
consider the whole range of territory that the 
cat covers, especially the poorly fed cat forced 
to forage for her food, and her intimacy with 
members of a family, especially with children, it 
is questionable whether the cat is a desirable 
pet. 

Since children, who are likely to handle a cat 
a good deal and come into close contact with it, 
are peculiarly susceptible to the diseases which 
the cat may 'carry, the writer believes that it 
would be better not to have a cat at all, or, if a 
cat is kept, as Dr. Osborne has suggested, she 
should be kept away from sources of infection 

133 



THE TEACHING OF HYGIENE 

or from people having disease. A cat known to 
be infected should either be disposed of or kept 
away from children. Stray cats, if they are har- 
bored, should be cared for with the thought in 
mind that they may be infected. 

The foregoing information and suggestions, not 
found in the ordinary school textbooks, the writer 
believes should be presented in all schools. It 
could best be taught, perhaps, in connection with 
the rat. 

The keeping of the cat has usually been defended 
on economic grounds, namely, that she catches 
rats and mice. Careful investigation shows, how- 
ever, that comparatively few cats habitually at- 
tack rats and that traps are more effective than 
cats in catching mice. Investigation proves that 
the cat, instead of being an economic asset, is a 
positive economic burden. Forbush (29) sums 
the matter up thus: — 

It is a member of one of the most bloodthirsty and 
carnivorous families of the mammalia, and makes 
terrific inroads on weaker creatures. It is particu- 
larly destructive to certain insect-eating forms of life, 
such as birds, moles, shrews, toads, etc. Every year 
the cats of New England undoubtedly destroy mil- 
lions of birds and other useful creatures, therefore 
indirectly aiding the increase of insects which de- 

134 



IMPORTANT PROBLEMS 

stroy crops and trees. Such insects possibly cost the 
people of Massachusetts from seven and one half 
million to nine million dollars annually. The cat 
protects them, thus increasing the cost of living to 
every citizen. The good that cats accomplish in the 
destruction of field mice, woods mice, and insects is 
of little consequence beside the ravages they inflict 
among insectivorous birds and other insect-eating 
and mouse-eating creatures. 

Public opinion is not ready now and may never 
be ready to dispose of cats entirely, so the school 
should tell the truth about them and the way 
they may be controlled. Forbush suggests that 
this can be done by reducing the number of cats 
to a minimum, limiting breeding, destroying su- 
perfluous kittens at birth, restraining or confin- 
ing cats kept as pets and as ratters (particularly 
at night and during the breeding-season of the 
birds), quarantining cats in cases of infectious 
diseases, and destroying all stray and feral cats, 
wherever they may be found. 

Teachers will find the scholarly and fascinat- 
ing bulletin of Edward Howe Forbush, The Do- 
mestic Cat (Economic Biology Bulletin no. 2, State 
Board of Agriculture, Boston, 19 16, pp. 112), 
of unusual interest and value. 



135 



THE TEACHING OF HYGIENE 

18. Training for emergencies 

Some of our textbooks in physiology and hy- 
giene have given some brief suggestions as to 
what should be done in emergencies, but the 
authors have invariably believed that skill in do- 
ing could be satisfactorily gained by merely im- 
parting knowledge. Some books, for example, 
have given explicit directions, reinforced by cuts, 
showing what to do in case of drowning. So far 
as the subject has been taught the children were 
asked to produce the words of the text. To com- 
mit such material to memory is exceedingly un- 
interesting to children. What is learned is seldom 
understood, and it is doubtful whether anybody 
with such knowledge has been able to apply it 
correctly at a critical time. What is needed is not 
mere book knowledge, but training, and instead 
of this topic being one of the driest in hygiene, 
it may be made one of the most interesting be- 
cause the child's love of action may be used to 
advantage. Children may be taught to make 
bandages, apply them to make-believe wounds, 
carry a companion assumed to be injured, re- 
suscitating one feigning suffocation, etc. This 
kind of training enables the individual in an emer- 
gency to act promptly and also to control the 






IMPORTANT PROBLEMS 

emotions. It would be amusing if it were not 
sometimes serious to see how helpless most people 
are in giving assistance to others who have been 
cut or bruised. If hygiene is a practical rather 
than a theoretical subject this training in emer- 
gencies should be of vital importance. It seems 
fully as significant as being able to do cube 
root or locate Baltimore. The writer believes 
that the work of an entire grade, possibly the 
seventh, should be devoted to emergencies. 

Training may be given not only by dramas, 
but it may have a more practical application. 
Children at school are likely to have cuts, 
bruises, and burns. Under such conditions there 
is usually no hygienic method of treatment. In 
the case of a wound a dirty rag or a soiled hand- 
kerchief may be wrapped around it to stop the 
flow of blood so that the wound is liable to be 
infected. When such a condition arises, the ideas 
and habits that have already developed from the 
systematic work on emergencies should now find 
their direct practical application. An emergency 
outfit should be on hand so that the children with 
the suggestion of the teacher may treat the case 
themselves. Assuming that the teacher is trying to 
get along at a minimum of expense, I suggest the 
following as being indispensable for the purpose : — 
137 



THE TEACHING OF HYGIENE 

Pins, common and safety. 

i dram bottle oil of cloves (for toothache; a drop 
on cotton in cavity). 

i pair scissors. 

i small package of absorbent cotton; bandages 
(may be bought at the drug store or loosely 
woven pieces of clean cloth may be brought from 
home by the children). 

i roll of surgeon's plaster. 

i small bottle of carron oil (for burns). 

i package of borax (for gargle). 

i half -pint of witch hazel (for sprains), one quar- 
ter of a pound of creolin (Pearson's) ; one tea- 
spoonful in one pint of water makes antiseptic 
solution. 

i ounce boracic acid (i eye wash). 

If it is impossible at first to get these, bandages 
may at least be made and a small supply of 
creolin or other antiseptic provided. Much of 
this material, if not all of it, may be supplied in 
small quantities by the children. Drug stores, 
too, will often give samples of creolin, etc. Care 
should be taken that emergency materials are 
not exposed to the dust. It is desirable that 
such materials should be put into a box that has 
a secure cover. A box measuring 11x10x4! 
inches on the inside would suffice. This box 
should be readily accessible. The little book, 

138 



IMPORTANT PROBLEMS 

Emergencies, of the Gulick Hygiene Series (Ginn 
& Co.), is almost indispensable for teacher and 
pupils. The subject-matter which it contains 
should be presented in all schools. The interested 
teacher who does not wish to buy this book may 
receive much valuable information from Lynch's 
First Aid in the Home. This pamphlet of fifty- 
seven pages may be received free from the Metro- 
politan Life Insurance Company, New York. 

iq. Prevention of fires and accidents 

Knowledge of what to do in case of an emer- 
gency, and practical training in applying this 
knowledge, are secondary in importance, how- 
ever, to the prevention of all conditions that 
endanger health and life. 

It is estimated that the fire losses for 191 2 in 
the United States and Canada, due to ignorance 
and carelessness, amounted to $196,000,000, and 
that many lives were also lost. The problem of 
fire prevention is therefore one of importance 
both to economics and hygiene. This problem, 
if attacked by children in the seventh or eighth 
grades, might be approached by asking children to 
read the newspapers for a certain length of time 
and report on the causes of fires. It will be found 
that most fires are due to negligence. The Fire 

139 



THE TEACHING OF HYGIENE 

Prevention Commissioner of Massachusetts gives 
these valuable suggestions which might be useful 
to teachers : — 

CELLAR 

i. Keep your cellar free from rubbish and waste 
paper. Place no combustible material under 
the stairways. 

2. Never put hot ashes in a wooden box or barrel. 

3. Be sure your chimney, furnace, and furnace 
pipes are in good condition. Have them in- 
spected in the fall before starting your fires. 

4. If you have paints or oils in the cellar, put them 
in a metal box with metal cover. 

5. Do not let your furnace become overheated. 

6. Keep smoke pipes, heat pipes, and gas jet away 
from woodwork. Protect the ceiling over your 
furnace. 

7. Do not try to thaw out frozen water pipes with 
a flame. Such pipes are usually situated where 
a flame will easily do great damage. Wrap the 
frozen part of the pipe with cotton cloth, and 
pour hot water upon it. 

KITCHEN 

8. Use safety matches. If you must use common 
matches, keep them in a metal box with metal 
cover. 

9. Look out for stove polishes and metal polishes. 

140 






IMPORTANT PROBLEMS 

Many of them contain naphtha. Do not use 

them near a flame. 
10. Keep no greasy or oily cloths, or waste, except 

in metal cans, with metal covers. 
ii. Keep your kerosene can and kerosene lamp in 

good condition. Do not use a glass lamp. Get a 

copy of " ¥ -rosene Cautions " from your oilman. 

12. Never hang clothing or cloths back of the stove. 
Never place them too near the stove. 

13. Do not use gasoline or naphtha for cleansing in 
your home. The vapors given off when mixed 
with air are explosive. 

14. Do not let your range become overheated. 

OTHER PARTS OF THE HOME 

15. Under NO conditions let children have matches. 
Keep the matches where the children cannot get 
them. 

16. Do not leave young children alone in the house. 
If you cannot take them with you, some good 
neighbor will be glad to look out for them. 

17. Never take a candle or a lamp into a closet. 

18. Never allow a gas jet where it may reach a cur- 
tain, or woodwork. 

19. Do not smoke in bed, or on a couch. 

20. Extinguish matches and cigarettes before throw- 
ing them away. 

21. Be careful about electric lights. Don't put too 
many lights, or motors, on the wires in your 
home. Consult your wire inspector. 

141 



THE TEACHING OF HYGIENE 

22. Keep a window, or windows, open in your bed- 
room at night. Smoke destroys more life than 
fire. For lack of this precaution, six lives were 
lost at one fire in Chelsea last summer. 

THE YARD 

23. Do not allow rubbish to collect in the shed or 
yard. Especially do not allow it to be piled 
against the house. 

24. Light no rubbish or leaf fires without the permit 
of the Chief of the Fire Department. 

The instruction given in regard to prevention 
of fire, like other instruction in hygiene, should 
function in action and habit, but training chil- 
dren in this has limitations in the school. The 
teacher can only hope to make the children in- 
telligent in regard to fire prevention and present 
the subject so concretely and vividly that habit 
may result. Something could be done by asking 
children to write a composition telling what 
they do in their own homes that might possibly 
lead to a fire. These compositions could then be 
considered by the class and suggestions given. 
Afterwards the children might be asked to report 
until certain habits were formed. The care of 
ashes might be one of the problems discussed 
and afterwards followed up in the reports. A 
142 



IMPORTANT PROBLEMS 

discussion of the prevention of fire and the train- 
ing of children might be a profitable topic for dis- 
cussion at a parent-teachers' association. 

An excellent textbook for children on fire 
prevention is Weeks's The Avoidance of Fires. 
(New York: D. C. Heath & Co., 1916, pp. 128.) 

The rush and tear of our modern life are respon- 
sible for an alarming yearly "accident" death- 
rate and the making of a vast number of cripples. 
Rosenau says that " about ten thousand persons 
are killed and one hundred thousand more or less 
seriously injured on the railroads of the United 
States every year." Much of this is preventable. 
The Interstate Commerce Commission, in its 
Report for 191 2, states that during that year 
5434 persons were killed while trespassing on 
railroad property and 5687 were injured. Many 
of these trespassers were children. It is estimated 
that within the last twenty years twenty-five 
thousand young people under eighteen years of 
age — many of them under ten years of age — 
have been killed and injured. Besides trespassing, 
lack of precaution in crossing tracks and board- 
ing and alighting from cars are chiefly responsible 
for accidents. The accidents to both children 
and adults from railroads, automobiles, etc., 
have led several States to pass laws requiring 

143 



THE TEACHING OF HYGIENE 

the school to give instruction on safety. Every 
teacher should know the geography of the region 
from which the children come and the dangers to 
which they are particularly subject. Every child 
needs to be informed as to possible dangers and 
how they may be avoided. When it is known that 
children are recklessly exposing themselves to 
accidents, such as stealing rides, boarding or 
alighting from moving cars, crossing the street 
in front of or just behind cars, automobiles, etc., 
cooperation with the parents and sometimes with 
the police is desirable. Older children may get 
valuable training by safeguarding the younger 
ones on their way to and from school. 

The Great Northern Railway gives these sug- 
gestions for the prevention of deaths and injuries 
on and about railroads: — 

i. Don't attempt to cross a track in front of a 
moving train; wait until it passes. 

2. Don't attempt to cross a track without first 
stopping and listening, and looking in both di- 
rections to see if a train is approaching. 

3. Don't step off one track on to another to let a 
train pass; step clear off ALL tracks. 

4. Don't stand upon or near tracks to carry on a 
conversation or kill time. It is extremely dan- 
gerous, especially at stations and crossings and 
in yards. 

144 



IMPORTANT PROBLEMS 

5. Don't use the tracks as a pathway; there is un- 
limited space outside of the rails and off the 
railroad company's right of way where you are 
free from danger. 

6. Don't permit dumb brutes to be on crossings 
or tracks if you can prevent it. It is both dan- 
gerous and cruel. Drive them off. 

7. Don't permit children to play or go upon the 
tracks for any purpose. 

8. Don't get on or off trains while in motion. 

9. Don't stand up in trains or unnecessarily pass 
from one part of the train to another while in 
motion. 

10. Don't get on trains on which you do not intend 
to become a passenger and remain thereon until 
after the train has started. Say good-bye to 
your friends before getting on the train. 

11. Don't allow boys to indulge in the dangerous 
practice of "hopping" on and off moving cars 
and trains. 

12. Don't steal rides on trains. 

13. Don't stand or walk on track until train is al- 
most upon you before getting off; have a due 
respect for the engineer's feelings and promptly 
observe the warnings he sounds for your protec- 
tion. 

14. Don't stand on platforms or in open doorways 
of moving coaches, and don't place hand on 
posts or jamb or open door; the movement of 
train may swing the door shut and mash your 
hand. 

145 



THE TEACHING OF HYGIENE 

15. Don't place suitcases, satchels, or other heavy 
packages in racks in coaches, as they are liable 
to fall out and injure those sitting under- 
neath. 

16. Don't throw banana peels, orange peels, or other 
fruit remnants on floor of station or car, out of 
car windows at stations, or in other places where 
they are liable to be stepped upon. 

DON'T BE RECKLESS OR FOOLHARDY — YOU 

WILL EVENTUALLY PAY THE PRICE 

IF YOU ARE 

Lessons on safety would be exceedingly unin- 
teresting and largely useless if they were con- 
fined merely to teaching children certain rules 
of conduct, like "Wait until the car stops before 
you get off." Such a procedure would be like 
committing the dictionary to memory. All these 
practical ideas on safety must be presented in 
such a way that they will interest. Stories founded 
on local examples of accidents, to which many of 
the children can contribute personal experience, 
will often be effective. The teacher, of course, will 
need to use caution in the selection of these danger 
stories, so that they may be adapted to the age 
of the pupils. Teachers should aim to develop 
prudence rather than fear. The teacher may 
find it helpful to keep an envelope for newspa- 
146 



IMPORTANT PROBLEMS 

per clippings and pictures which can be used in 
connection with the lessons on safety. The Bul- 
letin of the Department of Public Instruction 
of the State of New Jersey on The Teaching of 
Hygiene and Safety suggests some stories about 
safety that have been told with success. The 
forces that are chiefly responsible for accidents 
— steam, automobiles, fire, and electricity — 
are considered as giants which do good, but may 
be harmful if they are not properly controlled. 
This is the one on " Steam ": — 

Once there was a man who sat before a fire; there 
was a kettle on the fire and it was singing; steam was 
coming out of its nose and the lid was bobbing. He 
watched it a long time and then a fairy whispered in 
his ear — or maybe it was the song the kettle was 
singing — this: " There's a Giant in that kettle; 
catch him and build a strong harness around him and 
he will pull your ships across the ocean without sails, 
and pull your trains across the land." And they 
caught the Steam Giant and built an iron harness — 
a machine we call an engine — and he pulls ships 
across the sea and trains across the land. His name 
is Steam. He does great things, goes fast and does 
many good things; but sometimes he does cruel 
things. If you get too near Steam it will burn you — 
scald you; and if you walk on the railroad track, 
sometimes he can't stop and runs over you. 

147 



THE TEACHING OF HYGIENE 

Children will enjoy reading Bailey's Sure Pop 
and the Safety Scouts. (Yonkers-on-Hudson, New 
York: World Book Company, 191 6, pp. 128.) 

20. Mental hygiene 

The school should further the mental as well as 
the physical life of the child. As Dr. Burnham has 
suggested, "It is better to prevent mental dis- 
order by observing the principles of hygiene in 
the school than to cure disease by re-education 
in the sanitarium." Getting the child to conform 
to the simple and well-established hygienic rules 
relating to exercise, sleep, food, fresh air, temper- 
ance in all things, etc., are all involved in mental 
health, but mental hygiene proper, so far as it 
affects the school, refers to the proper way of 
learning. Intellectual activity is as fundamen- 
tally instinctive as physical activity, and the 
school must provide plenty of the right kind and 
direct it in the proper way. This means that 
children should form habits of proper alternation 
of work and rest, avoidance of worry, forming of 
orderly associations, natural reaction to feeling, 
self-control, and wholesome attitudes and inter- 
ests. 

From the foregoing it will be seen that men- 
tal hygiene is not a subject to be taught, but an 
148 



IMPORTANT PROBLEMS 

end to be gained. The personality of the teacher 
will determine in large measure success or failure 
in attaining the end. The sour, nagging, pessi- 
mistic, unsympathetic teacher will excite hatred 
for the school, fretfulness, worry, despondency, 
and nervousness. The teacher who keeps herself 
physically fit, enjoys her leisure and her work, 
loves children, has a variety of interests, a whole- 
some philosophy, and a hopeful and optimistic 
attitude toward her profession naturally inspires 
success, concentration of attention, freedom from 
hurry and nervousness, mental poise, and an 
attitude of leisure and enjoyment, all of which 
are essential to health, happiness, and usefulness. 
A more detailed treatment of mental hygiene 
will be found in Terman, The Hygiene of the 
School Child (Boston: Houghton Mifflin Com- 
pany, 1914, pp. 289-334); Beik, The Hygiene of 
Instruction (Educational Hygiene, edited by L. 
W. Rapeer. New York: Charles Scribner's Sons, 
19^, PP- 5 6 7-6o2). 



VI 

THE TEACHING OF HYGIENE IN THE 
RURAL SCHOOLS 1 

i. Is the country healthier than the city? 

It is usually assumed that the country is health- 
ier than the city, and, without careful study of 
the facts, this assumption would seem to be justi- 
fied. The country offers space, quiet, sunshine, 
fresh milk, home-grown fruits and vegetables, 
and an occupation necessitating vigorous exer- 
cise in the open air. The congested city suffers 
from the lack of these things, yet with all these 
serious handicaps, the city has probably out- 
stripped the country in its healthfulness because 
it has paid more attention to the fundamental 
principles of sanitation and hygiene. The dia- 
gram on the next page shows how the mortality 
rate in New York City has steadily decreased 
while the death rate in the rural districts has re- 
mained about the same over the same length of 
time. In 19 10 New York City was as healthy as 

1 The author is preparing a volume entitled Health Educa- 
tion in Rural Schools. 

150 



IN THE RURAL SCHOOLS 

the rural districts and since that time it has had 
a lower death-rate. This is a situation which is 
probably typical of the whole United States, for 
recent sanitary surveys in country districts show 
deplorable conditions. 



1900 1 



21 



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19 
18 
17 
16 
15 
14 
13 

A similar comparison may be made between 
the health of school pupils in city and country. 
Dr. Thomas D. Woods (59), whose extensive 
investigations allow him to speak with authority, 
says: "Statistics show that most physical de- 
fects are as prevalent, or more prevalent, among 
pupils in rural schools as among those who go 
to schools in the city." 

151 



THE TEACHING OF HYGIENE 

2. Present sanitation in rural schools 

A comparison of the sanitation in rural and 
city schools would reveal even wider differences. 
Fortunately a number of rather extensive inves- 
tigations have been made and the needs of the 
rural schools have been set forth. We shall refer 
to only one which might be regarded as typical. 
Dr. Fletcher B. Dresslar (23) sent out a ques- 
tionnaire to the two counties regarded as most 
progressive in nineteen different States. Twelve 
hundred and ninety-two returns were received. 
Considering these as fairly typical of the condi- 
tions of the rural schools throughout the country, 
the situation is deplorable. Sixty-three per cent 
of the buildings are old, and even the newer ones 
in the majority of cases have been built with little 
thought of hygiene. The lighting is usually bad, 
three fourths of the desks are non-adjustable, and 
the jacketed stove is seldom encountered. Nearly 
two thirds of the schools depend for their water- 
supply on springs and wells outside of the school 
grounds, so that neither clean nor fresh water is 
available in most cases. The open bucket and 
common drinking-cup are still in use, and even 
when the individual cups are used they are not 
infrequently mixed. The doors and windows of 
152 



IN THE RURAL SCHOOLS 

the schoolhouses are seldom screened. Toilet fa- 
cilities are generally a disgrace and a menace to 
the health of the community. Not more than one 
per cent of the toilets is sanitary. The school- 
grounds are, as a rule, too small for the children's 
play. To add to this the people of the community 
are usually ultra-conservative and in little sym- 
pathy with progress in hygiene and sanitation. 

5. Minimum essentials in sanitation 

How far the average school buildings are from 
even minimum requirements is easily seen by 
reading "Ten Sanitary Commandments for 
Rural Schools" prepared by the National Com- 
mittee on Health Education of the National 
Education Association in a pamphlet on The 
Minimum Requirements for Rural Schools (Chi- 
cago, 1914). 

The commandments are as follows : — 

In every school which may be considered passably 

sanitary the following conditions shall obtain: — 

1. Heating by at least a properly jacketed stove. 

(No un jacketed stove to be allowed.) Avoid 

overheating. Temperature should never go 

above 68° F. 

Ventilation by direct outdoor air inlets and 
by adequate and direct foul air outlets. 

153 



THE TEACHING OF HYGIENE 1 

2. Lighting from left outside of room or from left 
and rear through window space at least one 
fifth of floor space in area. 

3. Cleanliness of school as good as in the home of a 
careful housekeeper. 

4. Furniture sanitary in kind, and easily and fre- 
quently cleaned. Seats and desks adjustable 
and hygienic in type. 

5. Drinking water from a pure source provided by 
a sanitary drinking fountain. 

6. Facilities for washing hands, and individual 
towels. 

7. Toilets and privies sanitary in type and in care 
(with no cesspools unless water-tight) and no 
neglected privy-boxes or vaults. 

8. Flies and mosquitoes excluded by thorough 
screening of schoolhouse and toilets. 

9. Obscene and defacing marks absolutely absent 
from schoolhouse and privies. 

10. Playground of adequate size for every rural 
school. 

4. Status of teaching of hygiene 

There are few data on the teaching of hygiene 
in the rural schools, but considering the lack 
of professional training of the majority of the 
teachers and the slowness with which the latest 
ideas are received, it is fair to assume that it is, 
if anything, inferior to that offered in the city. 

154 



IN THE RURAL SCHOOLS 

Hodges, in his compilation from superintendent's 
reports of important features of rural school im- 
provement, does not refer once to any special 
achievement in health instruction, although the 
reports show that many districts have been ac- 
tive in introducing systematic work in domestic 
science and in getting play apparatus. 

Cubberley, in his Rural Life and Education (21) 
(Houghton Mifflin Company), says: "We have 
been teaching physiology for nearly a half century 
in our schools, yet of how little practical use it has 
been to us ! . . . We have learned the names and 
number of our bones, the pairs of muscles and 
nerves, and the anatomical construction of our 
different organs, but of practical hygiene we have 
learned but little." 

5. Some special difficulties and their solutions 

The teaching of hygiene in rural schools should 
not differ fundamentally as regards aims and 
methods from the teaching of the same subject 
in city schools. But since there are some problems 
of sanitation peculiar to the country there must 
necessarily be an introduction of new subject- 
matter, and similar topics must have a slightly 
different emphasis; for it must be remembered 
that the information imparted and the habits 

155 



THE TEACHING OF HYGIENE 

inculcated should aid the child to solve the health 
problems in the country. 

One difficulty which the rural teacher is likely 
to encounter is the ultra-conservatism of the 
average rural community. Unless the teacher is 
cautious and tactful her efforts are likely to be 
misinterpreted and barren of results. The train- 
ing of the pupils in hygiene and the elevation of 
the community demands the cooperation of the 
parents. Meeting with parents is highly desira- 
ble. This may often be brought about by plan- 
ning with the children a short but interesting en- 
tertainment to which the parents may be invited. 
After the entertainment is over the parents may 
be invited to stay to talk over with the teacher 
some of their common problems, among these 
matters pertaining to health. The teacher may 
then explain some of her aims and point out, for 
example, the value of habit in health and how 
the home and the school may cooperate. There 
should be, of course, a number of meetings, and, 
if they are to be successful, the teacher must 
plan not merely to get the parents to listen, but 
to do something. Such meetings, if well managed, 
ought to give the parents insight and sympathy 
with the teacher's efforts and also give them 
much new and valuable information. 

156 






IN THE RURAL SCHOOLS 

Another common difficulty is the lack of 
models of sanitation in the community. For 
example, in a great many rural communities it 
would be almost impossible to find a model dairy. 
When such a dairy is within easy range, the pu- 
pils may correlate observation with the informa- 
tion presented by the teacher and the textbook. 
Such field trips are exceedingly valuable in 
arousing interest and imparting exact knowledge. 
When such concrete observation is not available, 
the teacher may supply the deficiency to some 
extent by showing pictures. Fortunately, the 
rural school is a community and has some of the 
same problems of sanitation and hygiene as 
the homes from which the children come. It is 
the business of the teacher to see that the pupils 
are well informed, inspired, and trained to do 
something to make the school community to a 
large extent a model in hygiene and sanitation. 

One example will suffice. Probably the most 
crying need of the country is a sanitary disposi- 
tion of its sewerage. Dr. North (42) says that in- 
vestigation indicates that sixty per cent of the 
wells in the United States are polluted with house 
and barnyard drainage; that human and animal 
excreta are usually exposed to flies in a manner 
that makes it easy to transfer bacteria to the 

157 



THE TEACHING OF HYGIENE 

home and to the food of its occupants. It should 
also be said that the vile and loathsome school 
privy, too often found in the rural schools, is a 
menace to the health of the school, and is a type 
of danger which threatens every rural district. In 
some States of the South where the hookworm 
has been prevalent, the lack of outhouses and the 
insanitary outhouses have been an especially 
loathsome and dangerous source of disease. Pu- 
pils should be correctly informed as to the dan- 
gers from the insanitary outhouse. The question 
might then be proposed to the children: "Is our 
own outhouse sanitary?" Some teachers have 
found it advisable to suggest that a committee 
known as the " Board of Health," make an in- 
vestigation and report with recommendations. 
This may lead to asking the school authorities 
first to put the outhouse in a sanitary condition, 
promising, however, that it will be kept so there- 
after. It might also mean that the children 
would volunteer to do some things to make it 
sanitary. The discussion involved would include 
consideration of the fly problem, the washing of 
the hands after coming from the toilet, etc. An 
attack upon a practical problem in this fashion 
gives the children information which is likely 
to be retained and inculcates some habits and 
158 



IN THE RURAL SCHOOLS 

ideals likely to be permanent. Indirectly it may 
be relied upon to influence the community. The 
fly, rat, cat, mosquito, lunch, dust, heating, ven- 
tilating, and play problems may be approached 
in the same practical way. 

The following references to hygiene and sanita- 
tion will be serviceable to the teacher: — 

Dr. H. B. Bashore, The Sanitation of a Country House. 
(New York: Wiley & Sons, Inc.) 

(Gives teachers a good idea of what is necessary to make 
a country home healthful.) 

Dr. H. B. Bashore, Outlines of Rural Hygiene. (New 
York: Wiley & Sons, Inc.) 

(Brief treatment of most important health problems.) 

I. W. Brewer, Rural Hygiene. (Philadelphia: J. B. Lippin- 
cott Company, 1909, pp. 227.) 

(A rational treatment of rural health problems.) 
Fletcher B. Dresslar, Rural Schoolhouses and Grounds. 
(United States Bureau of Education, Bulletin No. 
12, 1914, pp. 162.) 

(A careful study of rural school architecture with many 
practical suggestions for teachers.) 

S. P. Gates, Farm Water Supplies. (Massachusetts State 
Board of Agriculture, Boston, Circular no. 18, 1914. 
pp. 8.) 

(Describes the advantages and disadvantages of dif- 
ferent kinds of wells, and how water may be best made 
available. Refers more to the methods of getting water 
than to hygiene. Illustrated.) 

X. H. Goodnough, The Sanitary Side of Farm Water Sup- 
159 



THE TEACHING OF HYGIENE 

plies. (Massachusetts State Board of Agriculture, 
Boston, Circular no. 43, 191 5, pp. 11.) 
(Excellent.) 

Charles E. North, M.D., Sanitation in Rural Communi- 
ties. (Current Educational Topics no. 3, United 
States Bureau of Education, Bulletin no. 496, 191 2, 
pp. 22.) 

(Interesting presentation of rural health problems and 
methods of solution.) 

H. W. Riley, Sewerage Disposal for Country Homes. (Pub- 
lished under direction of A. L. Martin, Director of 
Institutes, Commonwealth of Pennsylvania, Harris- 
burg, 1914, pp. 42. Also published by New York 
State College of Agriculture at Cornell University, 
Sanitation Series no. 4.) 

(" Last word on drainage for rural homes." Tells how 
sewerage plant may be constructed at minimum cost. 

C. W. Stiles, Country Schools and Rural Sanitation. 
(United States Public Health Service, Reprint no. 
116, 1913, pp. 5.) 
(Shows plainly the sanitary needs of rural schools.) 

C. W. Stiles, The Sanitary Privy. (United States Depart- 
ment of Agriculture, Farmers' Bulletin, no. 463, 
1915, PP. 32.) 
(Drawings, plans. Very valuable.) 

G. C. Whipple, Pure Water. (State Board of Health of 
Jacksonville, Florida, Publication 128, 1914, pp. 21.) 
(Gives a good idea of the dangers of an impure water- 
supply and what a city water-supply ought to be. Illus- 
trated.) 

The Danger Zone on the Farm — Sewerage Disposal. (Vir- 
160 



IN THE RURAL SCHOOLS 

ginia State Board of Health Bulletin, vol. vn, no. 6, 
pp. 248-62.) 

(Excellent. Describes in detail how to make a sanitary 
outhouse. Many drawings.) 

The Sanitary Box. (Virginia Health Bulletin, vol. vi, 
extra no. 6, pp. 136-38.) 

(How to build a sanitary device cheap enough for the 
poorest home. Drawing.) 

6. The importance of training 

This book has failed utterly in its purpose 
if it has not made clear to the reader that the 
teacher's work is to be judged, not by the charac- 
ter or the amount of information that the chil- 
dren acquire, but by improved tendencies in 
behavior, particularly in the formation of hy- 
gienic habits. The effective teacher of hygiene is 
one who trains her pupils to act in the right way. 

In our best city schools, under the stimulus 
of medical inspection, a good beginning has 
been made in actually training children to con- 
serve and improve their health; but the vast 
majority of our rural schools have scarcely be- 
gun to consider the problem. This has been 
shown by every recent survey of rural schools. 
The survey of the rural schools of Porter County, 
Indiana (18a), by the United States Public 
Health Service shows, for example, that 18.3 
161 



THE TEACHING OF HYGIENE 

per cent of the boys and 10.5 per cent of the girls 
never used a toothbrush at all, and the daily 
use of the toothbrush was noted in but 13.9 per 
cent of the boys and in 40.9 per cent of the girls. 
An investigation of the other hygienic habits 
would probably show the same deplorable lack 
of school training. 

In previous pages many suggestions have been 
offered as to how this training may be given. 
Dr. Burnham (38a) has recently suggested that 
in every rural school a training class might be 
formed. He describes a visit to a rural school, 
and offers suggestions as to training in these 
words: — 

Recently I visited a little rural school of excel- 
lent character. The teacher was intelligent, sensible, 
interested in her work. She had splendid discipline 
without any apparent show of authority. The chil- 
dren were bright, helpful, obedient, active, ready 
to play hard at recess, ready to work in the school- 
room. But apart from the admirable discipline and 
the scholastic training in the matter of studying the 
daily lessons, the work of the schoolroom seemed 
to be all instruction with little or no training. That 
there was plenty of opportunity in this school for 
training was obvious. The children might have been 
more careful in their own personal hygiene; their 
teeth especially were not properly cared for. As 
162 



IN THE RURAL SCHOOLS 

regards the schoolhouse, the toilets, although new, 
were unsanitary; in the schoolroom the curtains 
shut out the light from the upper half of the window 
where it was needed; a little later in the season the 
room would probably be overheated or improperly 
heated. In general, the sanitary condition could 
have been much improved. 

This school is typical of a large number, probably 
of most schools, in the rural districts in this coun- 
try. In such a school a training class in hygiene 
would find plenty of opportunity for learning. 
Among its exercises could be included the acquisi- 
tion of habits of personal hygiene, normal posture, 
special care of the teeth, care of the school grounds, 
cleanliness of the schoolroom, the use of fresh earth, 
if nothing better, in the toilets every day, adjust- 
ment of the windows for proper ventilation with 
regard to the direction of the wind, the regulation 
of the temperature of the room, adjustment of the 
curtains, and the like. Membership in such a class 
should be made a mark of honor, since service is 
always honorable. 

With a tactful teacher such a class would give 
training that would be far more valuable than mere 
instruction in hygiene. The school can do little in 
the way of giving instruction, but it will accomplish 
a great deal if it develops an hygienic attitude and 
fosters the acquisition of certain habits of health 
that will remain permanent after the children leave 
school. Instruction is good and it is easy; training 

163 



THE TEACHING OF HYGIENE 

is better but it is difficult. The past decade has 
been a period of talk about school hygiene, the 
next decade should be one of training in school 
hygiene. 



BIBLIOGRAPHY 

i. L. R. Alderman, School Credit for Home Work. (Bos- 
ton: Houghton Mifflin Company, 1915, pp. 
181.) 

2. J. Mace Andress, "The Teaching of Hygiene in 

Elementary Schools." Chapter xxv in Edu- 
cational Hygiene, edited by L. W. Rapeer. (New 
York: Charles Scribner's Sons, 1915.) 

3. "The Teaching of Hygiene Below the High 

School." Elementary School Teacher (March and 
April, 1914). 

4. "What Results Should we Expect from the 

Teaching of Hygiene in the Elementary 
Schools?" Educational Standards (March, 
1916). 

5. "Suggestions for the Effective Teaching of 

Hygiene in the Rural Schools." The Rural 
School Teacher (September, October, 191 5). 

6. "Free Publications for Teachers of Hygiene." 

The Rural School Teacher (November, Decem- 
ber, 191 5). 

6a. " Health Education in Rural Schools." Amer- 
ican Journal of School Hygiene (March, April, 
1917), PP- 49-53, 80-88. 

6b. " The Study of Habit in a Course in Psychol- 
ogy, with Special Reference to Health Hab- 
its. American Journal of School Hygiene (Sep- 
tember, 1917), pp. 126-30. 

165 



BIBLIOGRAPHY 

7. Donald B. Armstrong, "Social Aspects of Industrial 

Hygiene." American Journal of Public Health, 
vol. vi (19 1 6), pp. 546-54. 

8. J. H. Beard, " The Avoidable Loss of Life." Popular 

Science Monthly, vol. n (February, 19 16), pp. 
105-18. 

9. Charles Scott Berry, Physiology and Hygiene in 

il High-School Education." Edited by Charles 
Hughes Johnson. (New York: Charles Scrib- 
ner's Sons, pp. 346-60.) 

10. John S. Billings, Physiological Aspects of the Liquor 

Problem (1903), p. 23. 

11. Edward F. Brown, "Suggesting Another Method of 

Teaching Personal Hygiene." School and So- 
ciety, vol. iv, no. 82 (1916), pp. 148-51. 

12. Thomas J. Browne, "Habit and Posture." Ameri- 

can Physical Education Review, vol. xxi 
(1916), pp. 89-98, 176-90. 

13. Franklin Bobbitt, What the Schools Teach and Might 

Teach. (Cleveland: The Survey Committee of 
the ClevelandFoundation, 1916, pp. 82-87.) 

14. W. H. Burnham, A Health Examination at School 

Entrance." Pedagogical Seminary, vol. xxi 
(1914), pp. 219-41. 

15. "Orderly Association as a Condition of Men- 
tal Health." Pedagogical Seminary, vol. xx, 
pp. 360-91. 

16. Mental Hygiene for School. (United States 

Bureau of Education, Bulletin no. 48, 1913, 
pp. 68-70.) 

16a. "The Effect of Tobacco on Mental Efficiency." 
Pedagogical Seminary (September, 191 7), pp. 
297-317. 

166 



BIBLIOGRAPHY 

17. Richard C. Cabot, "The Teaching of Hygiene." 

American Physical Education Review, vol. xiv 
(1909), pp. 352-58. 

18. W. W. Charters, Teaching the Common Branches. 

(Boston: Houghton Mifflin Company, 1913, 
pp. 300-09.) 
1 8a. Clark Collins Treadwell, Rural School Sanitation, 
• Including Physical and Mental Status of School 
Children in Porter County, Indiana. (United 
States Public Health Bulletin no. 77, pp. 87.) 

19. Ward Crampton, "The Teaching of Hygiene." Pro- 

ceedings, Fourth Congress of American School 
Hygiene Association (1910), pp. 138-42. 

20. Clifford Crosby, "Physiology, How and How 

Much?" School Science and Mathematics, vol. 
vn (1907), p. 738. 

21. Ell wood P. Cubberley, Rural Life and Education. 

(Boston: Houghton Mifflin Company, 19 14, 
pp. 264-65.) 

22. The Portland Survey. (Yonkers-on-Hudson: The 

World Book Company, 191 5, pp. 361-62.) 

23. Fletcher B. Dresslar, "The Hygiene of the Rural 

School." Proceedings and Addresses, National 
Education Association (191 2), pp. 1 103-10. 
23a. George W. Ehler, " Preparation for Peace or War." 
The Playground, vol. x, no. 5 (August, 191 6), 
pp. 72-78. 

24. John A. Ferrell, The Rural School and Hookworm 

Disease. (United States Bureau of Education, 
Bulletin no. 20, 1914, pp. 43.) 

25. Irving Fisher and Eugene Lyman Fisk, How to Live. 

(New York: Funk & Wagnalls Company, 19 15, 
PP- 345-) 

167 



BIBLIOGRAPHY 

26. Irving Fisher, Bulletin of the Committee of One Hun- 

dred on National Health. (Washington, D.C., 
1909, pp. 138.) 

27. Abraham Flexner and Frank P. Bachman, Public 

Education in Maryland. A Report to the Mary- 
land Educational Survey Commission (19 16), 
pp. 176. 

28. Roy K. Flannagan, Sanitary Survey of the Schools of 

Orange County, Virginia. (United States Bu- 
reau of Education, 1914, Bulletin no. 17, pp. 28.) 

29. Edward Howe Forbush, The Domestic Cat. (Eco- 

nomic Biology Bulletin no. 2, Massachusetts 
State Board of Agriculture, Boston, 1916, pp. 
108.) 

30. Rats and Rat Riddance. (Economic Biology 

Bulletin no. 1, Massachusetts State Board of 
Agriculture, Boston, pp. 87.) 

31. F. M. Gregg, "Teaching Hygiene as Nature 

Study." Proceedings, Fourth International 
Congress on School Hygiene (i9i4),pp. 262-69. 

32. Harry W. Haight, "The Case System of Teaching 

Hygiene and Preventive Medicine in the Upper 
Grades." Educational Review, vol. xlix (191 5), 

PP- 503-09. 

33. Hemenway, American Public Health Protection. 

(Indianapolis: Bobbs-Merrill Company, 1916, 
PP. 283.) 

34. Henry H. Hills, Jr., The Present Position of Infant 

Mortality. Its Recent Decline in the United 
States. (Quarterly Publications of the American 
Statistical Association, December, 191 5.) 

35. E. A. Hines, " School Hygiene Simplified — The Re- 

ward System." Proceedings, Fourth Interna- 

168 



BIBLIOGRAPHY 

tional Congress on School Hygiene, vol. in 
(1014), pp. 225-29. 

36. Ernest B. Hoag, Organized Health Work in Schools. 

(United States Bureau of Education, 1913, 
Bulletin no. 44, pp. 56.) 

37. C. F. Hodge, " Learning Disease Prevention in 

School — The House-Fly as a Practical Les- 
son." Proceedings, Fourth International Con- 
gress on School Hygiene, vol. ni (19 14), pp. 
10-14. 

38. C. L. Hunt and M. Ward, School Lunches. (United 

States Department of Agriculture, Farmers' 
Bulletin no. 712, pp. 26.) 
38a. G. E. Jones, Hygiene and War. (Introduction by 
Dr. W. H. Burnham.) (Carnegie Endowment for 
International Peace, Washington, pp. 23-24.) 

39. C. N. Kendall and G. A. Mirick, How to Teach the 

Fundamental Subjects. (Boston: Houghton 
Mifflin Company, 19 15, pp. 289-315.) 

40. Frank M. McMurry, Elementary School Standards. 

(Yonkers-on-Hudson: World Book Company, 

1913, PP- 5i-54, 148-54.) 

41. Moseley, "Some Ways of Teaching Practical Hy- 

giene." School Science and Mathematics, (Jan- 
uary, 191 2.) 

42. Charles E. North, Sanitation in Rural Communities. 

(United States Bureau of Education, Bulletin 
no. 496, pp 22.) 

43. Caroline A. Osborne, "The Cat: A Neglected Factor 

in Sanitary Science." Pedagogical Seminary 
(December, 1907), pp. 439-60. 

44. Louis W. Rapeer, School Health Administration. 

(New York: Teachers College, 1913, pp. 358.) 

169 



BIBLIOGRAPHY 

45. Louis W. Rapeer, Rural School Hygiene. A section 

of the Pennsylvania Rural School Report (19 14), 
pp. 24. 

46. "School Health Responsibilities." Reprinted 

from School and Home Education, pp. 8. 

47. (editor). Educational Hygiene. (New York: 

Charles Scribner's Sons, 191 5.) 

48. Milton J. Rosenau, Preventive Medicine and Hy- 

giene. (New York: D. Appleton & Co., pp. 
1074.) 

49. Willard S. Small, Educational Hygiene. Report of 

the United States Commissioner of Education 
(1915), vol. 1, pp. 408-23. 

50. W. S. Small, "Health Teaching in High Schools," in 

Educational Hygiene, edited by L. W. Rapeer. 
(New York: Charles Scribner's Sons, 1915, pp. 
494-518.) 

51. F. C. Smith, Exercise and Health. (United States 

Public Health Service, Supplement no. 24 to the 
Public Health Reports, 1915, pp. 7.) 

52. Franz Schneider, Jr., "A Survey of the Activities of 

Municipal Health Departments in the United 
States." American Journal of Public Health, 
vol. vi (1916), pp. 1-18. 

53. A. M. Stimpson, The Citizen and the Public Health, 

(United States Public Health Service, Supple- 
ment no. 4 to the Public Health Reports, 19 13, 
pp. 12.) 

54. Lewis M. Terman, The Health of the School Child. 

(Boston: Houghton Mifflin Company, 1914, 
pp. 416.) 

55- The Teacher's Health. (Boston: Houghton 

Mifflin Company, 1913, pp. 137.) 

170 



BIBLIOGRAPHY 

56. Terman and Hoag, Health Work in the Schools. (Bos- 

ton: Hough ton Mifflin Company, 1914, pp. 321.) 

57. G. W. Turner, "An Experiment in Student Control 

of School Sanitation and Hygiene.' ' Proceed- 
ings, Fourth International Congress on School 
Hygiene, vol. m (1913), pp. 283-88. 

58. Thomas D. Woods, Health and Education. Ninth 

Year-Book of the National Society for the 
Study of Education, part 1, pp. 113. 

59. Thomas D. Woods, "Health Problems in the Ameri- 

can Public Schools." Proceedings and Ad- 
dresses, New England Association (1914), pp. 
294-301. 

60. Lillian M. Towne, "The Teaching of Hygiene." 

Proceedings, Fourth International Congress on 
School Hygiene, vol. in (1913), pp. 225-29. 

61. "School Instruction in the Effects of Stimulants 

and Narcotics." Educational Review, vol. xxrv 
(1902), pp. 31-47. 

62. Editorial, "The Lag of Health Laws Behind Sci- 

ence." American Journal of Public Health, 
vol. vi, pp. 560-61. 

63 . Carnegie Foundation for the Advancement of Teach- 

ing, Bulletin no. 7 (New York, 1914), pp. 416. 

64. "A Health Survey of White County, Illinois." 

Illinois Health News, vol. 11, no. 2 (February, 
1916), pp. 19-38. 

65. The Teaching of Hygiene and Safety. (State of New 

Jersey Department of Public Instruction, Tren- 
ton, 1915, pp. 156.) 

66. Tentative Course of Study for the Elementary School, 

Kansas City. (Missouri Public Schools, 19 15, 
pp. 113-72.) 

171 



BIBLIOGRAPHY 

SELECTED LIST OF BEST REFERENCE 
BOOKS FOR TEACHERS 

Jessie H. Bancroft, The Posture of School-Children. (New 
York: The Macmillan Company, pp. 322. $1.50.) 

(Contains many helpful suggestions on the training of 
children in correct posture. Almost indispensable to any 
school.) 

Jessie H. Bancroft, Games for the Playground, Home, 
School and Gymnasium. (New York: The Macmillan 
Company, 1917, pp. 456. $1.50.) 
(The most complete manual on plays and games.) 

Isaac William Brewer, Rural Hygiene. (Philadelphia: 
J. B. Lippincott Company, 1909, pp. 227. $1.25.) 

(An interesting and practical treatment of the health 
problems of the country.) 

F. W. and J. D. Burks, Health and the School. (New 
York: D. Appleton & Co., pp. 393. $1.50.) 

(An interesting presentation of hygiene through round 
table discussions.) 

Henry S. Curtis, Play and Recreation for the Open Country. 
(Boston: Ginn & Co., 1914, pp. 265. $1.25.) 

(Special consideration of the problems of rural recrea- 
tion. One part devoted to the play of the Rural School. 
Illustrated. Excellent.) 

Fletcher B. Dresslar, School Hygiene. (New York: The 
Macmillan Company, 1913, pp. 369. $1.25.) 

(Particularly good on the sanitation of the school 
plant.) 

Fisher and Fisk, How to Live. (New York: Funk & Wag- 
nails Company, pp. 345. $1.00.) 
(The best single volume on personal hygiene.) 
172 



BIBLIOGRAPHY 

T. W. Galloway, Biology of Sex, for Parents and Teachers. 
(New York: D.C. Heath & Co.,ioi3,pp. 105. $1.00.) 
(A temperate discussion of sex hygiene.) 

Luther H. Gulick, The Efficient Life. (New York: Double- 
day, Page & Co., 1913, pp. 195. $1.20.) 
(Personal hygiene, attractive style, carries conviction.) 

Hough and Sedgwick, The Human Mechanism. (Boston: 
Ginn & Co., 1906, pp. 564. $2.00.) 
(Excellent reference for general physiology and hygiene.) 

Woods Hutchinson, Preventable Diseases. (Boston: 
Houghton Mifflin Company, 1909, pp. 442. $1.50.) 
(Popular, interesting, profitable for general reading.) 

Joseph Lee, Play in Education. (New York: TheMac- 
millan Company, pp. 494. $1.50.) 

(A delightful interpretation of play, a book every 
teacher ought to read.) 

L. W. Rapeer {editor), Educational Hygiene. (New 
York: Charles Scribner's Sons, pp. 639. $2.25.) 

(A contribution to practically every phase of educa- 
tional hygiene by leading experts.) 

Lewis M. Terman, The Hygiene of the School Child. (Bos- 
ton: Houghton Mifflin Company, 1914, pp. 417. 
$1.65.) 
(Latest information on the health of the school child.) 
Lewis M. Terman, Health Work in the Schools. (Boston: 
Houghton Mifflin Company, 1914, pp. 321. $1.60.) 
(Contains helpful matter for the grade teacher.) 

Lewis W. Terman, The Teacher's Health. (Boston: 
Houghton Mifflin Company, pp. 136. 70 cts.) 

(Contains helpful suggestions on the hygiene of teach- 
ing and the teacher's health.) 

173 



BIBLIOGRAPHY 

George Lincoln Walton, Why Worry? (Philadelphia: 
J. B. Lippincott Company, 1909, pp. 269. $1.00.) 

(A popular and interesting treatment of a bad habit. 
Useful for any teacher, a helpful book to lend.) 



OUTLINE 

I. THE FUNDAMENTAL IMPORTANCE OF 

HYGIENE IN THE CURRICULUM 

i. The value of health I 

2. The outlook for the prevention of illness and 

the lengthening of human life 6 

3. The relative importance of hygiene in the cur- 

riculum 10 

II. THE STATUS OF THE TEACHING OF 

HYGIENE 

1 . Reports from surveys and other investigations. 1 2 

2 . Hygiene not regarded as fundamental ; its teach- 

ingafailure 18 

3. Why the teaching of hygiene has failed 19 

III. THE GOALS OF INSTRUCTION 

1. The acquisition of knowledge 26 

2. The formation of health habits 31 

3. The establishing of ideals 35 

IV. SUGGESTIONS ON METHOD 

1. Health as a motive ineffective 39 

2. Some motives that will work 42 

3. The psychology of habit formation 46 

4. Habits to be formed and to be avoided 49 

175 



OUTLINE 

5. Give marks for habits formed 51 

6. Special honors for hygienic living 52 

7. Training in habit formation in school 53 

8. Methods of getting children to form habits out- 

side of school 54 

9. Study the health of your pupils 58 

10. Cooperate with medical inspector 62 

11. Get cooperation of parents 62 

1 2. Health clubs 65 

13. Planning the course of study 66 

14. The plan of work in the first four grades 67 

15. The plan of work in Grades V-VIII 74 

16. Free printed matter on hygiene 75 

17. How secured — general sources of supply 76 

18. How used — some general suggestions 78 

19. Planning a health day — making use of printed 

matter, exhibits, essays 81 

V. IMPORTANT PROBLEMS AND THEIR 
SOLUTION 

1. Alcohol and health 86 

2. The use of tobacco 93 

3. Prevention and care of colds 95 

4. Fresh air and tuberculosis 96 

5. Cleanliness 98 

6. Exercise and play 100 

7. Care of the teeth 105 

8. Foods and hygiene of feeding 107 

9. Pure milk in 

10. Elimination of intestinal wastes 112 

176 



OUTLINE 

ii. The care of the eyes 114 

12. The care of babies 115 

13. Sex hygiene 116 

14. The house fly 1 19 

15. The mosquito 1 24 

16. The destruction of rats and mice 126 

17. The cat and sanitation 132 

18. Training for emergencies 136 

19. Prevention of fires and accidents 139 

20. Mental hygiene 148 

VI. THE TEACHING OF HYGIENE IN THE 
RURAL SCHOOLS 

1. Is the country healthier than the city? 150 

2. Present sanitation in rural schools 152 

3. Minimum essentials in sanitation 153 

4. Status of the teaching of hygiene 154 

5. Some special difficulties and their solution. ... 155 

6. The importance of training 161 



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